Walled Carotid Bifurcation Phantoms for Imaging Investigations of Vessel Wall Motion and Blood Flow Dynamics

Efficacy of a hands-free vascular ultrasound probe holder in active and inactive limbs during cycling exercise

Measurement of blood flow during exercise is crucial for understanding physiological responses and performance outcomes. However, traditional methods are often invasive, costly, or require substantial training, limiting widespread research in this area. This study introduces the innovative use of limb-affixed ultrasound probe holders for vascular imaging during exercise to overcome these challenges. We investigated a commercially available probe holder, the Usono ProbeFix dynamic (PFD), in capturing artery diameter and blood velocity during dynamic exercise compared with a trained sonographer. Twenty healthy adults (11 females) underwent simultaneous imaging of the brachial artery and superficial femoral artery (SFA) using both manual and PFD imaging on separate days. Data were collected for 60 s at rest on a cycle ergometer and after 4 min of cycling at 50, 100, and 150 W. The PFD was comparable with a trained sonographer at rest (both 99 ± 2%) but demonstrated superiority in capturing blood velocity in the inactive limb (main effect of scanning condition P < 0.01; e.g., 150 W exercise: 85 ± 21% vs. 74 ± 25%). There was no effect of scanning condition on velocity capture success in the SFA (main effect: 69 ± 21% vs. 65 ± 16%; P = 0.42). A systematic constriction of brachial artery diameter (∼0.02 cm) was noted in the PFD condition (P < 0.01), likely due to the compression of the shallow artery. The findings suggest that ultrasound probe holders offer a promising solution for increasing accessibility to exercising blood flow in vascular physiology research, though require considerations for data cleaning and diameter assessment. Further investigation is warranted to optimize the application of these devices in dynamic exercise scenarios.NEW & NOTEWORTHY This study explores an ultrasound probe holder (PFD) for measuring blood flow during exercise, addressing the limitations of traditional methods. We compared PFD imaging with manual scanning in capturing artery diameter and blood velocity during cycling exercise. Results showed that the PFD matched trained sonographer accuracy at rest and outperformed them in capturing blood velocity during exercise in the inactive limb but not active limb. We highlight the PFD's potential impact in vascular physiology research.

Fabrication, characterization and numerical validation of a novel thin-wall hydrogel vessel model for cardiovascular research based on a patient-specific stenotic carotid artery bifurcation

In vitro vascular models, primarily made of silicone, have been utilized for decades for studying hemodynamics and supporting the development of implants for catheter-based treatments of diseases such as stenoses and aneurysms. Hydrogels have emerged as prominent materials in tissue-engineering applications, offering distinct advantages over silicone models for fabricating vascular models owing to their viscoelasticity, low friction, and tunable mechanical properties. Our study evaluated the feasibility of fabricating thin-wall, anatomical vessel models made of polyvinyl alcohol hydrogel (PVA-H) based on a patient-specific carotid artery bifurcation using a combination of 3D printing and molding technologies. The model's geometry, elastic modulus, volumetric compliance, and diameter distensibility were characterized experimentally and numerically simulated. Moreover, a comparison with silicone models with the same anatomy was performed. A PVA-H vessel model was integrated into a mock circulatory loop for a preliminary ultrasound-based assessment of fluid dynamics. The vascular model's geometry was successfully replicated, and the elastic moduli amounted to 0.31 ± 0.007 MPa and 0.29 ± 0.007 MPa for PVA-H and silicone, respectively. Both materials exhibited nearly identical volumetric compliance (0.346 and 0.342% mmHg-1), which was higher compared to numerical simulation (0.248 and 0.290% mmHg-1). The diameter distensibility ranged from 0.09 to 0.20% mmHg-1 in the experiments and between 0.10 and 0.18% mmHg-1 in the numerical model at different positions along the vessel model, highlighting the influence of vessel geometry on local deformation. In conclusion, our study presents a method and provides insights into the manufacturing and mechanical characterization of hydrogel-based thin-wall vessel models, potentially allowing for a combination of fluid dynamics and tissue engineering studies in future cardio- and neurovascular research.

Biomimicking Atherosclerotic Vessels: A Relevant and (Yet) Sub-Explored Topic

Atherosclerosis represents the etiologic source of several cardiovascular events, including myocardial infarction, cerebrovascular accidents, and peripheral artery disease, which remain the leading cause of mortality in the world. Numerous strategies are being delineated to revert the non-optimal projections of the World Health Organization, by both designing new diagnostic and therapeutic approaches or improving the interventional procedures performed by physicians. Deeply understanding the pathological process of atherosclerosis is, therefore, mandatory to accomplish improved results in these trials. Due to their availability, reproducibility, low expensiveness, and rapid production, biomimicking physical models are preferred over animal experimentation because they can overcome some limitations, mainly related to replicability and ethical issues. Their capability to represent any atherosclerotic stage and/or plaque type makes them valuable tools to investigate hemodynamical, pharmacodynamical, and biomechanical behaviors, as well as to optimize imaging systems and, thus, obtain meaningful prospects to improve the efficacy and effectiveness of treatment on a patient-specific basis. However, the broadness of possible applications in which these biomodels can be used is associated with a wide range of tissue-mimicking materials that are selected depending on the final purpose of the model and, consequently, prioritizing some materials' properties over others. This review aims to summarize the progress in fabricating biomimicking atherosclerotic models, mainly focusing on using materials according to the intended application.

Polyvinyl Alcohol Phantoms With Heterogeneous Plaques: Estimation of Pulse Wave Velocity at the Stenotic Region Using Pulse Wave Imaging

OBJECTIVE

Plaque characterization is essential for stroke prevention. In the study reported herein, we describe a heterogeneous phantom manufacturing technique with varying plaque compositions of different stiffness using polyvinyl alcohol (PVA) to emulate stenotic arteries and evaluated the use of pulse wave imaging (PWI) to assess plaque stiffness by comparing derived pulse wave velocities, with the goal of assessing plaque vulnerability and identifying high-risk patients for stroke.

METHODS

Five stenotic phantoms (50% stenosis) were fabricated by pouring PVA solutions into 3-D-printed molds. Two of the phantoms had heterogeneous plaque compositions of soft (E0 = 13 kPa) and intermediate (E0 = 40 kPa) materials and of stiff (E0 = 54 kPa) and intermediate materials. Ultrasound sequences were acquired as the arterial phantoms were connected to a pulsating pump, and PWI was performed on the ultrasound acquisition using normalized cross-correlation to track the pulse-induced phantom wall distension propagations. Pulse wave velocities were estimated by fitting a linear regression line between the arrival time of the peak acceleration of the wall distension waveform and the corresponding location.

RESULTS

Arterial phantoms with heterogeneous plaque stiffness were successfully fabricated. Pulse wave velocities of 2.06, 2.21, 2.49, 2.67 and 3.31 m/s were found in the phantom experiments using PWI for homogeneous soft plaque, the heterogeneous soft and intermediate plaque, homogeneous intermediate plaque, the heterogeneous stiff and intermediate plaque and homogeneous stiff plaque, respectively.

CONCLUSION

A novel arterial phantom building technique was reported with varying heterogenous plaque compositions of different stiffness. The feasibility of using PWI to evaluate plaque stiffness in stenotic arteries was determined and found that PWI can distinguish between plaques of distinct stiffness and composition.

Dual-Probe Transcranial Full-Waveform Inversion: A Brain Phantom Feasibility Study

OBJECTIVE

Despite being a low-cost, portable and safe medical imaging technique, transcranial ultrasound imaging is not used widely in adults because of the severe degradation and distortion of signals caused by the skull. Full-waveform inversion (FWI) has recently been found to have potential as an effective method for transcranial ultrasound tomography to obtain high-quality, subwavelength-resolution acoustic models of the brain using low-frequency ultrasound data. In this study is the first demonstration of this method in recovering a high-resolution 2-D reconstruction of a brain and skull ultrasound imaging phantom using experimentally acquired data.

METHODS

A 2:5 scale brain phantom encased within a 3-D-printed skull-mimicking layer was created to simulate a clinical transcranial imaging target. To obtain tomographic ultrasound data on the brain and skull phantom, a tomographic ultrasound acquisition system was designed and implemented using commercially available low-frequency cardiac probes. FWI reconstructions of the brain and skull phantom were performed using the acquired tomographic data and were compared with corresponding synthetic reconstructions. This comparison was used to evaluate the feasibility of the proposed imaging system when employing different transducer array configurations.

RESULTS

We demonstrate the successful FWI reconstruction of the brain phantom within the skull mimic from experimentally acquired tomographic ultrasound data. To mitigate the effects of the skull-mimicking material, a reflection-matching algorithm was applied to model the morphology of the skull layer prior to performing the inversion.

CONCLUSION

The findings of this study provide a promising step toward the clinical use of FWI for transcranial ultrasound imaging in adults.

Precise Estimation of Intravascular Pressure Gradients

This study presents a method for noninvasive pressure gradient estimation, which allows the detection of small pressure differences with higher precision compared to invasive catheters. It combines a new method for estimating the temporal acceleration of the flowing blood with the Navier-Stokes equation. The acceleration estimation is based on a double cross-correlation approach, which is hypothesized to minimize the influence of noise. Data are acquired using a 256-element, 6.5-MHz GE L3-12-D linear array transducer connected to a Verasonics research scanner. A synthetic aperture (SA) interleaved sequence with 2 ×12 virtual sources evenly distributed over the aperture and permuted in emission order is used in combination with recursive imaging. This enables a temporal resolution between correlation frames equal to the pulse repetition time at a frame rate of half the pulse repetition frequency. The accuracy of the method is evaluated against a computational fluid dynamic simulation. Here, the estimated total pressure difference complies with the CFD reference pressure difference, which yields an R -square of 0.985 and an RMSE of 3.03 Pa. The precision of the method is tested on experimental data, measured on a carotid phantom of the common carotid artery. The volume profile used during measurement was set to mimic flow in the carotid artery with a peak flow rate of 12.9 mL/s. The experimental setup showed that the measured pressure difference changes from -59.4 to 31 Pa throughout a single pulse cycle. This was estimated with a precision of 5.44% (3.22 Pa) across ten pulse cycles. The method was also compared to invasive catheter measurements in a phantom with a 60% cross-sectional area reduction. The ultrasound method detected a maximum pressure difference of 72.3 Pa with a precision of 3.3% (2.22 Pa). The catheters measured a maximum pressure difference of 105 Pa with a precision of 11.2% (11.4 Pa). This was measured over the same constriction and with a peak flow rate of 12.9 mL/s. The double cross-correlation approach revealed no improvement compared to a normal differential operator. The method's strength, thus, lies primarily in the ultrasound sequence, which allows precise and accurate velocity estimations, at which acceleration and pressure differences can be acquired.

Pulse wave imaging of a stenotic artery model with plaque constituents of different stiffnesses: Experimental demonstration in phantoms and fluid-structure interaction simulation

Vulnerable plaques associated with softer components may rupture, releasing thrombotic emboli to smaller vessels in the brain, thus causing an ischemic stroke. Pulse Wave Imaging (PWI) is an ultrasound-based method that allows for pulse wave visualization while the regional pulse wave velocity (PWV) is mapped along the arterial wall to infer the underlying wall compliance. One potential application of PWI is the non-invasive estimation of plaque's mechanical properties for investigating its vulnerability. In this study, the accuracy of PWV estimation in stenotic vessels was investigated by computational simulation and PWI in validation phantoms to evaluate this modality for assessing future stroke risk. Polyvinyl alcohol (PVA) phantoms with plaque constituents of different stiffnesses were designed and constructed to emulate stenotic arteries in the experiment, and the novel fabrication process was described. Finite-element fluid-structure interaction simulations were performed in a stenotic phantom model that matched the geometry and parameters of the experiment in phantoms. The peak distension acceleration of the phantom wall was tracked to estimate PWV. PWVs of 2.57 ms-1, 3.41 ms-1, and 4.48 ms-1 were respectively obtained in the soft, intermediate, and stiff plaque material in phantoms during the experiment using PWI. PWVs of 2.10 ms-1, 3.33 ms-1, and 4.02 ms-1 were respectively found in the soft, intermediate, and stiff plaque material in the computational simulation. These results demonstrate that PWI can effectively distinguish the mechanical properties of plaque in phantoms as compared to computational simulation.

Design and Construction of a Low-Frequency Ultrasound Acquisition Device for 2-D Brain Imaging Using Full-Waveform Inversion

The main techniques used to image the brain and obtain structural data are magnetic resonance imaging and X-ray computed tomography. These techniques produce images with high spatial resolution, but with the disadvantage of requiring very large equipment with special installation needs. In addition, X-ray tomography uses ionizing radiation, which limits their use. Ultrasound imaging is a safe technology that is delivered using compact and mobile devices. However, conventional ultrasound reconstruction techniques have failed to obtain images of the brain because of, fundamentally, the presence of the skull and the distortion that it produces on ultrasound. Recent studies have indicated that full-waveform inversion, a computational technique originally from Earth science, has the potential to generate accurate 3-D images of the brain. This technology can overcome the limitations of conventional ultrasound imaging, but a prototype for transcranial applications does not yet exist. Here, we investigate different designs of an annular array of ultrasound transducers to optimize the number of elements and rotations needed to conduct transcranial imaging with full-waveform inversion. This device uses small-diameter, low-frequency transducers that readily propagate ultrasound through the skull with good signal-to-noise ratios. It also incorporates the use of rotations to produce a high-density coverage of the target and acquire redundant traces that are beneficial for full-waveform inversion. We have built a ring of 40 transducers to illustrate that this design is capable of reconstructing images of the brain, retrieving its anatomy and acoustic properties with millimeter resolution. Laboratory results reveal the ability of this device to successfully image a 2.5-D brain- and skull-mimicking phantom using full-waveform inversion. To our knowledge, this is the first prototype ever used for transcranial-like imaging. The importance of these findings and their implications for the design of a 3-D reconstruction system with possible clinical applications are discussed.

Stride: A flexible software platform for high-performance ultrasound computed tomography

BACKGROUND AND OBJECTIVE

Advanced ultrasound computed tomography techniques like full-waveform inversion are mathematically complex and orders of magnitude more computationally expensive than conventional ultrasound imaging methods. This computational and algorithmic complexity, and a lack of open-source libraries in this field, represent a barrier preventing the generalised adoption of these techniques, slowing the pace of research, and hindering reproducibility. Consequently, we have developed Stride, an open-source Python library for the solution of large-scale ultrasound tomography problems.

METHODS

On one hand, Stride provides high-level interfaces and tools for expressing the types of optimisation problems encountered in medical ultrasound tomography. On the other, these high-level abstractions seamlessly integrate with high-performance wave-equation solvers and with scalable parallelisation routines. The wave-equation solvers are generated automatically using Devito, a domain-specific language, and the parallelisation routines are provided through the custom actor-based library Mosaic.

RESULTS

We demonstrate the modelling accuracy achieved by our wave-equation solvers through a comparison (1) with analytical solutions for a homogeneous medium, and (2) with state-of-the-art modelling software applied to a high-contrast, complex skull section. Additionally, we show through a series of examples how Stride can handle realistic numerical and experimental tomographic problems, in 2D and 3D, and how it can scale robustly from a local multi-processing environment to a multi-node high-performance cluster.

CONCLUSIONS

Stride enables researchers to rapidly and intuitively develop new imaging algorithms and to explore novel physics without sacrificing performance and scalability. This will lead to faster scientific progress in this field and will significantly ease clinical translation.

A probabilistic approach to tomography and adjoint state methods, with an application to full waveform inversion in medical ultrasound

Bayesian methods are a popular research direction for inverse problems. There are a variety of techniques available to solve Bayes' equation, each with their own strengths and limitations. Here, we discuss stochastic variational inference (SVI), which solves Bayes' equation using gradient-based methods. This is important for applications which are time-limited (e.g. medical tomography) or where solving the forward problem is expensive (e.g. adjoint methods). To evaluate the use of SVI in both these contexts, we apply it to ultrasound tomography of the brain using full-waveform inversion (FWI). FWI is a computationally expensive adjoint method for solving the ultrasound tomography inverse problem, and we demonstrate that SVI can be used to find a no-cost estimate of the pixel-wise variance of the sound-speed distribution using a mean-field Gaussian approximation. In other words, we show experimentally that it is possible to estimate the pixel-wise uncertainty of the sound-speed reconstruction using SVI and a common approximation which is already implicit in other types of iterative reconstruction. Uncertainty estimates have a variety of uses in adjoint methods and tomography. As an illustrative example, we focus on the use of uncertainty for image quality assessment. This application is not limiting; our variance estimator has effectively no computational cost and we expect that it will have applications in fields such as non-destructive testing or aircraft component design where uncertainties may not be routinely estimated.

Development of Custom Wall-Less Cardiovascular Flow Phantoms with Tissue-Mimicking Gel

PURPOSE

Flow phantoms are used in experimental settings to aid in the simulation of blood flow. Custom geometries are available, but current phantom materials present issues with degradability and/or mimicking the mechanical properties of human tissue. In this study, a method of fabricating custom wall-less flow phantoms from a tissue-mimicking gel using 3D printed inserts is developed.

METHODS

A 3D blood vessel geometry example of a bifurcated artery model was 3D printed in polyvinyl alcohol, embedded in tissue-mimicking gel, and subsequently dissolved to create a phantom. Uniaxial compression testing was performed to determine the Young's moduli of the five gel types. Angle-independent, ultrasound-based imaging modalities, Vector Flow Imaging (VFI) and Blood Speckle Imaging (BSI), were utilized for flow visualization of a straight channel phantom.

RESULTS

A wall-less phantom of the bifurcated artery was fabricated with minimal bubbles and continuous flow demonstrated. Additionally, flow was visualized through a straight channel phantom by VFI and BSI. The available gel types are suitable for mimicking a variety of tissue types, including cardiac tissue and blood vessels.

CONCLUSION

Custom, tissue-mimicking flow phantoms can be fabricated using the developed methodology and have potential for use in a variety of applications, including ultrasound-based imaging methods. This is the first reported use of BSI with an in vitro flow phantom.

Pressure Difference Estimation in Non-stenotic Carotid Bifurcation Phantoms Using Vector Flow Imaging

Local pressure differences estimated using vector flow imaging (VFI) and direct catheterization in seven carotid bifurcation phantoms were compared with simulated pressure fields. VFI correlated strongly with simulated peak pressure differences (r = 0.99, p < 0.00001), with an average overestimation of 12.3 Pa (28.6%). The range between the lowest and highest pressure difference of VFI underestimated simulations by 4.6 Pa (8.06%; r = 0.99, p < 0.0001). The catheter method exhibited no correlation (r = -0.09, p = 0.85). Ten repeated measurements on one phantom revealed a small standard deviation (SD) for VFI (SD = 8.4%, mean estimated SD = 11.5%), but not for the catheter method (SD = 785.6%). An in vivo peak systolic pressure difference of 97.9 Pa (estimated SD = 30%) was measured using VFI in one healthy individual. This study indicates that VFI pressure difference estimation is feasible in phantoms and in vivo and realistic estimates of the SD can be attained from the data.

Spatial Response Identification Enables Robust Experimental Ultrasound Computed Tomography

Ultrasound computed tomography techniques have the potential to provide clinicians with 3-D, quantitative and high-resolution information of both soft and hard tissues such as the breast or the adult human brain. Their practical application requires accurate modeling of the acquisition setup: the spatial location, orientation, and impulse response (IR) of each ultrasound transducer. However, the existing calibration methods fail to accurately characterize these transducers unless their size can be considered negligible when compared with the dominant wavelength, which reduces signal-to-noise ratios below usable levels in the presence of high-contrast tissues such as the skull. In this article, we introduce a methodology that can simultaneously estimate the location, orientation, and IR of the ultrasound transducers in a single calibration. We do this by extending spatial response identification (SRI), an algorithm that we have recently proposed to estimate transducer IRs. Our proposed methodology replaces the transducers in the acquisition device with a surrogate model whose effective response matches the experimental data by fitting a numerical model of wave propagation. This results in a flexible and robust calibration procedure that can accurately predict the behavior of the ultrasound acquisition device without ever having to know where the real transducers are or their individual IR. Experimental results using a ring acquisition system show that SRI produces calibrations of significantly higher quality than standard methodologies across all transducers, both in transmission and in reception. Experimental full-waveform inversion (FWI) reconstructions of a tissue-mimicking phantom demonstrate that SRI generates more accurate reconstructions than those produced with standard calibration techniques.

A Review of Carotid Artery Phantoms for Doppler Ultrasound Applications

Ultrasound imaging systems need tissue-mimicking phantoms with a good range of acoustic properties. Many studies on carotid artery phantoms have been carried out using ultrasound; hence this study presents a review of the different forms of carotid artery phantoms used to examine blood hemodynamics by Doppler ultrasound (DU) methods and explains the ingredients that constitute every phantom with their advantages and disadvantages. Different research databases were consulted to access relevant information on carotid artery phantoms used for DU measurements after which the information were presented systematically spanning from walled phantoms to wall-less phantoms. This review points out the fact that carotid artery phantoms are made up of tissue mimicking materials, vessel mimicking materials, and blood mimicking fluid whose properties matched those of real human tissues and vessels. These materials are a combination of substances such as water, gelatin, glycerol, scatterers, and other powders in their right proportions.

4D Reconstruction and Identification of Carotid Artery Stenosis Utilizing a Novel Pulsatile Ultrasound Phantom

As a major application focus of vascular ultrasonography, the carotid artery has long been the subject of phantom design and procedure focus. It is therefore important to devise procedures that are minimally invasive and informative, initially using a physiologically accurate anthropomorphic phantom to validate the methodology. In this article, a novel phantom design protocol is presented that enables the efficient production of a pulsatile ultrasound phantom consisting of soft and vascular tissue mimics, as well as a blood surrogate fluid. These components when combined give the phantom high acoustic compatibility and lifelike mechanical properties. The phantom was developed using "at-home" purchasable components and 3D printing technology. The phantom was subsequently used to develop a 4D reconstruction algorithm of the pulsing vessel in MATLAB. In pattern with recent developments in medical imaging, the 4D reconstruction enables clinicians to view vessel wall motion in a 3D space without the need for manual intervention. The reconstruction algorithm also produces measured inner luminal areas and vessel wall thickness, providing further information relating to structural properties and stenosis, as well as elastic properties such as arterial stiffness, which could provide helpful markers for disease diagnosis. © 2021 Wiley Periodicals LLC. Basic Protocol 1: Constructing a pulsatile ultrasound phantom model Support Protocol: Creating a vascular mimic mold Basic Protocol 2: Creating a 4D reconstruction from ultrasound frames.

Modeling Pulse Wave Propagation Through a Stenotic Artery With Fluid Structure Interaction: A Validation Study Using Ultrasound Pulse Wave Imaging

Pulse wave imaging (PWI) is an ultrasound-based method that allows spatiotemporal mapping of the arterial pulse wave propagation, from which the local pulse wave velocity (PWV) can be derived. Recent reports indicate that PWI can help the assessment of atherosclerotic plaque composition and mechanical properties. However, the effect of the atherosclerotic plaque's geometry and mechanics on the arterial wall distension and local PWV remains unclear. In this study, we investigated the accuracy of a finite element (FE) fluid-structure interaction (FSI) approach to predict the velocity of a pulse wave propagating through a stenotic artery with an asymmetrical plaque, as quantified with PWI method. Experiments were designed to compare FE-FSI modeling of the pulse wave propagation through a stenotic artery against PWI obtained with manufactured phantom arteries made of polyvinyl alcohol (PVA) material. FSI-generated spatiotemporal maps were used to estimate PWV at the plaque region and compared it to the experimental results. Velocity of the pulse wave propagation and magnitude of the wall distension were correctly predicted with the FE analysis. In addition, findings indicate that a plaque with a high degree of stenosis (>70%) attenuates the propagation of the pulse pressure wave. Results of this study support the validity of the FE-FSI methods to investigate the effect of arterial wall structural and mechanical properties on the pulse wave propagation. This modeling method can help to guide the optimization of PWI to characterize plaque properties and substantiate clinical findings.

Vortex dynamics and transport phenomena in stenotic aortic models using Echo-PIV

Atherosclerosis is the most fatal cardiovascular disease. As disease progresses, stenoses grow inside the arteries blocking their lumen and altering blood flow. Analysing flow dynamics can provide a deeper insight on the stenosis evolution. In this work we combined Eulerian and Lagrangian descriptors to analyze blood flow dynamics and fluid transport in stenotic aortic models with morphology, mechanical and optical properties close to those of real arteries. To this end, vorticity, particle residence time (PRT), particle's final position (FP) and finite time Lyapunov's exponents (FTLE) were computed from the experimental fluid velocity fields acquired using ultrasonic particle imaging velocimetry (Echo-PIV). For the experiments, CT-images were used to create morphological realistic models of the descending aorta with 0%, 35% and 50% occlusion degree with same mechanical properties as real arteries. Each model was connected to a circuit with a pulsatile programmable pump which mimics physiological flow and pressure conditions. The pulsatile frequency was set to ≈0.9 Hz (55 bpm) and the upstream peak Reynolds number (Re) was changed from 1100 to 2000. Flow in the post-stenotic region was composed of two main structures: a high velocity jet over the stenosis throat and a recirculation region behind the stenosis where vortex form and shed. We characterized vortex kinematics showing that vortex propagation velocity increases withRe. Moreover, from the FTLE field we identified Lagrangian coherent structures (i.e. material barriers) that dictate transport behind the stenosis. The size and strength of those barriers increased withReand the occlusion degree. Finally, from the PRT and FP maps, we showed that independently ofRe, the same amount of fluid remains on the stenosis over more than a pulsatile period.

3D-printed, patient-specific intracranial aneurysm models: From clinical data to flow experiments with endovascular devices

PURPOSE

Flow models of intracranial aneurysms (IAs) can be used to test new and existing endovascular treatments with flow modulation devices (FMDs). Additionally, 4D flow magnetic resonance imaging (MRI) offers the ability to measure hemodynamics. This way, the effect of FMDs can be determined noninvasively and compared to patient data. Here, we describe a cost-effective method for producing flow models to test the efficiency of FMDs with 4D flow MRI.

METHODS

The models were based on human radiological data (internal carotid and basilar arteries) and printed in 3D with stereolithography. The models were printed with three different printing layers (25, 50, and 100 µm thickness). To evaluate the models in vitro, 3D rotational angiography, time-of-flight MRI, and 4D flow MRI were employed. The flow and geometry of one model were compared with in vivo data. Two FMDs (FMD1 and FMD2) were deployed into two different IA models, and the effect on the flow was estimated by 4D flow MRI.

RESULTS

Models printed with different layer thicknesses exhibited similar flow and little geometric variation. The mean spatial difference between the vessel geometry measured in vivo and in vitro was 0.7 ± 1.1 mm. The main flow features, such as vortices in the IAs, were reproduced. The velocities in the aneurysms were similar in vivo and in vitro (mean velocity magnitude: 5.4 ± 7.6 and 7.7 ± 8.6 cm/s, maximum velocity magnitude: 72.5 and 55.1 cm/s). By deploying FMDs, the mean velocity was reduced in the IAs (from 8.3 ± 10 to 4.3 ± 9.32 cm/s for FMD1 and 9.9 ± 12.1 to 2.1 ± 5.6 cm/s for FMD2).

CONCLUSIONS

The presented method allows to produce neurovascular models in approx. 15 to 30 h. The resulting models were found to be geometrically accurate, reproducing the main flow patterns, and suitable for implanting FMDs as well as 4D flow MRI.

Helical toroid phantom for 3D flow imaging investigations

The medical physics community has hitherto lacked an effective calibration phantom to holistically evaluate the performance of three-dimensional (3D) flow imaging techniques. Here, we present the design of a new omnidirectional, three-component (3-C) flow phantom whose lumen is consisted of a helical toroid structure (4 mm lumen diameter; helically winded for 5 revolutions over a torus with 10 mm radius; 5 mm helix radius). This phantom's intraluminal flow trajectory embraces all combinations of x, y, and z directional components, as confirmed using computational fluid dynamics (CFD) simulations. The phantom was physically fabricated via lost-core casting with polyvinyl alcohol cryogel (PVA) as the tissue mimic. 3D ultrasound confirmed that the phantom lumen expectedly resembled a helical toroid geometry. Pulsed Doppler measurements showed that the phantom, when operating under steady flow conditions (3 ml s^-1 flow rate), yielded flow velocity magnitudes that agreed well with those derived from CFD at both the inner torus (-47.6 ± 5.7 versus -52.0 ± 2.2 cm s^-1; mean ± 1 S.D.) and the outer torus (49.5 ± 4.2 versus 48.0 ± 1.7 cm s^-1). Additionally, 3-C velocity vectors acquired from multi-angle pulsed Doppler showed good agreement with CFD-derived velocity vectors (<7% and 10° difference in magnitude and flow angle, respectively). Ultrasound color flow imaging further revealed that the phantom's axial flow pattern was aligned with the CFD-derived flow profile. Overall, the helical toroid phantom has strong potential as an investigative tool in 3D flow imaging innovation endeavors, such as the development of flow vector estimators and visualization algorithms.

Ultrasound Deep Learning for Wall Segmentation and Near-Wall Blood Flow Measurement

Studies of medical flow imaging have technical limitations for accurate analysis of blood flow dynamics and vessel wall interaction at arteries. We propose a new deep learning-based boundary detection and compensation (DL-BDC) technique in ultrasound (US) imaging. It can segment vessel boundaries by harnessing the convolutional neural network and wall motion compensation in the analysis of near-wall flow dynamics. The network enables training from real and synthetic US images together. The performance of the technique is validated through synthetic US images and tissue-mimicking phantom experiments. The neural network performs well with high Dice coefficients of over 0.94 and 0.9 for lumens and walls, outperforming previous segmentation techniques. Then, the performance of the wall motion compensation is examined for compliant phantoms. When DL-BDC is applied to flow influenced by wall motion, root-mean-square errors are less than 0.07%. The technique is utilized to analyze flow dynamics and wall interaction with varying elastic moduli of the phantoms. The results show that the flow dynamics and wall shear stress values are consistent with the expected values of the compliant phantoms, and their wall motion behavior is observed with pulse wave propagation. This strategy makes US imaging capable of simultaneous measurement of blood flow and vessel dynamics in human arteries for their accurate interaction analysis. DL-BDC can segment vessel walls fast, accurately, and robustly. It enables to measure the near-wall flow precisely by determining the vessel boundary dynamics. This approach can be beneficial in flow dynamics and wall interaction analyses in various biomedical applications.

A simple, realistic walled phantom for intravascular and intracardiac applications

PURPOSE

This work aims to develop a simple, anatomically and haptically realistic vascular phantom, compatible with intravascular and intracardiac ultrasound. The low-cost, dual-layered phantom bridges the gap between traditional wall-only and wall-less phantoms by showing both the vessel wall and surrounding tissue in ultrasound imaging. This phantom can better assist clinical tool training, testing of intravascular devices, blood flow studies, and validation of algorithms for intravascular and intracardiac surgical systems.

METHODS

Polyvinyl alcohol cryogel (PVA-c) incorporating a scattering agent was used to obtain vessel and tissue-mimicking materials. Our specific design targeted the inferior vena cava and renal bifurcations which were modelled using CAD software. A custom mould and container were 3D-printed for shaping the desired vessel wall. Three phantoms were prepared by varying both the concentrations of scattering agent as well as the number of freeze-thaw cycles to which the phantom layers were subjected during the manufacturing process. Each phantom was evaluated using ultrasound imaging using the Foresight™ ICE probe. Geometrical validation was provided by comparing CAD design to a CT scan of the phantom.

RESULTS

The desired vascular phantom was constructed using 2.5% and 0.05% scattering agent concentration in the vessel and tissue-mimicking layers, respectively. Imaging of the three phantoms showed that increasing the number of freeze-thaw cycles did not significantly enhance the image contrast. Comparison of the US images with their CT equivalents resulted in an average error of 0.9[Formula: see text] for the lumen diameter.

CONCLUSION

The phantom is anatomically realistic when imaged with intracardiac ultrasound and provides a smooth lumen for the ultrasound probe and catheter to manoeuvre. The vascular phantom enables validation of intravascular and intracardiac image guidance systems. The simple construction technique also provides a workflow for designing complex, multi-layered arterial phantoms.

Walled vessel-mimicking phantom for ultrasound imaging using 3D printing with a water-soluble filament: design principle, fluid-structure interaction (FSI) simulation, and experimental validation

The geometry and stiffness of a vessel are pertinent to blood dynamics and vessel wall mechanical behavior and may alter in diseased conditions. Ultrasound-based ultrafast Doppler (uDoppler) imaging and shear wave imaging (SWI) techniques have been extensively exploited for the assessment of vascular hemodynamics and mechanics. Their performance is conventionally validated on vessel-mimicking phantoms (VMPs) prior to their clinical use. Compared with commercial ones, customized VMPs are favored for research use because of their wider range of material properties, more complex lumen geometries, or wall structures. Fused deposition modeling (FDM) 3D printing technique with plastic filaments is a promising method for making VMPs with a complex vessel lumen. However, it may require a toxic solvent or a long dissolution time currently. In this paper, we present a safe, efficient and geometrically flexible method where FDM 3D printing with a water-soluble polyvinyl alcohol (PVA) filament is exploited to fabricate a walled three-branch VMP (VMP-I). As a key step in fabrication, to avoid dissolution of the PVA-printed vessel core by the solution of the tissue-mimicking material, paraffin wax was used for isolation. Paraffin wax is easy to coat (i.e. without any special equipment), of satisfactory thickness (∼0.1 mm), chemically stable, and easy to remove after fabrication, thus making the proposed method practicable for ultrasound imaging studies. VMP-I was examined by B-mode imaging and power Doppler imaging (PDI) to verify complete dissolution of PVA-printed vessel core in its lumen, confirming good fabrication quality. The flow velocities in VMP-I were estimated by uDoppler imaging with a -0.8% difference, and the shear wave propagation speeds for the same phantom were estimated by SWI with a -6.03% difference when compared with fluid-structure interaction (FSI) simulation results. A wall-less VMP of a scaled and simplified coronary arterial network (VMP-II) was additionally fabricated and examined to test the capability of the proposed method for a complex lumen geometry. The proposed fabrication method for customized VMPs is foreseen to facilitate the development of ultrasound imaging techniques for blood vessels.

A Systematic Review for the Design of In Vitro Flow Studies of the Carotid Artery Bifurcation

PURPOSE

In vitro blood flow studies in carotid artery bifurcation models may contribute to understanding the influence of hemodynamics on carotid artery disease. However, the design of in vitro blood flow studies involves many steps and selection of imaging techniques, model materials, model design, and flow visualization parameters. Therefore, an overview of the possibilities and guidance for the design process is beneficial for researchers with less experience in flow studies.

METHODS

A systematic search to in vitro flow studies in carotid artery bifurcation models aiming at quantification and detailed flow visualization of blood flow dynamics results in inclusion of 42 articles.

RESULTS

Four categories of imaging techniques are distinguished: MRI, optical particle image velocimetry (PIV), ultrasound and miscellaneous techniques. Parameters for flow visualization are categorized into velocity, flow, shear-related, turbulent/disordered flow and other parameters. Model materials and design characteristics vary between study type.

CONCLUSIONS

A simplified three-step design process is proposed for better fitting and adequate match with the pertinent research question at hand and as guidance for less experienced flow study researchers. The three consecutive selection steps are: flow parameters, image modality, and model materials and designs. Model materials depend on the chosen imaging technique, whereas choice of flow parameters is independent from imaging technique and is therefore only determined by the goal of the study.

Ultrasound Sub-pixel Motion-tracking Method with Out-of-plane Motion Detection for Precise Vascular Imaging

Ultrasound vascularity imaging provides important information for differential diagnosis of tumors. Peak-hold (PH) is a useful technique for precisely imaging small vessels by selecting a maximum brightness in each pixel through the frames obtained sequentially. To use PH successfully one needs motion compensation to reduce image blur, but out-of-plane motion cannot be avoided. To address this problem, we developed a sub-pixel motion-tracking method with out-of-plane motion detection (OPMD). It is a combination of the sum of the absolute differences (SAD) method and the Kanade-Lucas-Tomasi method and can be accurately applied to various motions. The value from OPMD (γ) is defined as a statistical value obtained from the distribution of residual values in the SAD procedure with the obtained frames. The value is ideally 0, and the frames having large γ are removed from the PH procedure. The accuracy of the proposed tracking method was found by a simulation study to be approximately 20 μm. We also found, through a phantom experiment, that the value of γ sensitively increased enough to detect out-of-plane motion. Most important, γ begins to increase before tracking errors occur. This suggests that OPMD can be used to predict tracking errors and effectively remove frames from the PH procedure. An in vivo experiment with a rabbit showed that the PH image obtained with motion tracking clearly revealed peripheral vessels that were blurred in the PH image obtained without motion tracking. We also found that the image quality becomes better when OPMD was used to remove frames including out-of-plane motion.

Deformable phantoms of the prostatic urinary tract for urodynamic investigations

PURPOSE

Assessment of urethral dynamics is clinically regarded to be important in analyzing the functional impact of pathological features like urethral obstruction, albeit it is difficult to perform directly in vivo. To facilitate such an assessment, urethra phantoms may serve well as investigative tools by reconstructing urethral dynamics based on anthropomorphic factors. Here, our aim is to design a new class of anatomically realistic, deformable urethra phantoms that can simulate the geometric, mechanical, and hydrodynamic characteristics of the male prostatic urethra.

METHODS

A new lost-core tube casting protocol was devised. It first involved the drafting of urethra geometry in computer-aided design software. Next, 3D printing was used to fabricate the urethra geometry and an outer mold. These parts were then used to cast a urinary tract using a polyvinyl alcohol (PVA)-based material (with 26.6 ± 4.0 kPa Young's elastic modulus). After forming a surrounding tissue-mimicking slab using an agar-gelatin mixture (with 17.4 ± 3.4 kPa Young's modulus), the completed urethra phantom was connected to a flow circuit that simulates voiding. To assess the fabricated phantoms' morphology, ultrasound imaging was performed over different planes. Also, color Doppler imaging was performed to visualize the flow profile within the urinary tract.

RESULTS

Deformable phantoms were devised for the normal urethra and a diseased urethra with obstruction due to benign prostatic hyperplasia (BPH). During voiding, the short-axis lumen diameter at the verumontanum of the BPH-featured phantom (0.91 ± 0.08 mm) was significantly smaller than that for the normal phantom (2.49 ± 0.20 mm). Also, the maximum flow velocity of the BPH-featured phantom (59.3 ± 5.8 cm/s; without Doppler angle correction) was found to be higher than that of the normal phantom (22.7 ± 9.0 cm/s).

CONCLUSION

The fabricated phantoms were effective in simulating urethra deformation resulting from urine passage during voiding. They can be used for mechanistic studies of urethral dynamics and for the testing of urodynamic diagnostic techniques in urology.

High frame rate doppler ultrasound bandwidth imaging for flow instability mapping

Purpose

Flow instability has been shown to contribute to the risk of future cardiovascular and cerebrovascular events. Nonetheless, it is challenging to noninvasively detect and identify flow instability in blood vessels. Here, we present a new framework called Doppler ultrasound bandwidth imaging (DUBI) that uses high‐frame‐rate ultrasound and Doppler bandwidth analysis principles to assess flow instability within an image view.

Methods

Doppler ultrasound bandwidth imaging seeks to estimate the instantaneous Doppler bandwidth based on autoregressive modeling at every pixel position of data frames acquired from high‐frame‐rate plane wave pulsing. This new framework is founded upon the principle that flow instability naturally gives rise to a wide range of flow velocities over a sample volume, and such velocity range in turn yields a larger Doppler bandwidth estimate. The ability for DUBI to map unstable flow was first tested over a range of fluid flow conditions (ranging from laminar to turbulent) with a nozzle‐flow phantom. As a further demonstration, DUBI was applied to assess flow instability in healthy and stenosed carotid bifurcation phantoms.

Results

Nozzle‐flow phantom results showed that DUBI can effectively detect and visualize the difference in Doppler bandwidth magnitude (increased from 2.1 to 5.2 kHz) at stable and unstable flow regions in an image view. Receiver operating characteristic analysis also showed that DUBI can achieve optimal sensitivity and specificity of 0.72 and 0.83, respectively. In the carotid phantom experiments, differences were observed in the spatiotemporal dynamics of Doppler bandwidth over a cardiac cycle. Specifically, as the degree of stenosis increased (from 50% to 75%), DUBI showed an increase in Doppler bandwidth magnitude from 1.4 kHz in the healthy bifurcation to 7.7 kHz at the jet tail located downstream from a 75% stenosis site, thereby indicating flow perturbation in the stenosed bifurcations.

Conclusion

DUBI can detect unstable flow. This new technique can provide useful hemodynamic information that may aid clinical diagnosis of atherosclerosis.

High-Frame-Rate Contrast Echocardiography Using Diverging Waves: Initial In Vitro and In Vivo Evaluation

Contrast echocardiography (CE) ultrasound with microbubble contrast agents has significantly advanced our capability for assessment of cardiac function, including myocardium perfusion quantification. However, in standard CE techniques obtained with line by line scanning, the frame rate and image quality are limited. Recent research has shown significant frame-rate improvement in noncontrast cardiac imaging. In this work, we present and initially evaluate, both in vitro and in vivo, a high-frame-rate (HFR) CE imaging system using diverging waves and pulse inversion sequence. An imaging frame rate of 5500 frames/s before and 250 frames/s after compounding is achieved. A destruction-replenishment sequence has also been developed. The developed HFR CE is compared with standard CE in vitro on a phantom and then in vivo on a sheep heart. The image signal-to-noise ratio and contrast between the myocardium and the chamber are evaluated. The results show up to 13.4-dB improvement in contrast for HFR CE over standard CE when compared at the same display frame rate even when the average spatial acoustic pressure in HFR CE is 36% lower than the standard CE. It is also found that when coherent compounding is used, the HFR CE image intensity can be significantly modulated by the flow motion in the chamber.

Arterial Phantoms with Regional Variations in Wall Stiffness and Thickness

Regional wall stiffening and thickening are two common pathological features of arteries. To account for these two features, we developed a new arterial phantom design framework to facilitate the development of vessel models that contain a lesion segment whose wall stiffness and thickness differ from those of other segments. This new framework is based on multi-part injection molding principles that sequentially casted the lesion segment and the flank segments of the vessel model using molding parts devised with computer-aided design tools. The vessel-mimicking material is created from polyvinyl alcohol cryogel, and its acoustic properties are similar to those of arteries. As a case demonstration, we fabricated a stenosed three-segment phantom composed of a central lesion segment (5.1-mm diameter, 1.95-mm wall thickness, 212.6-kPa elastic modulus) and two flank segments (6.0-mm diameter, 1.5-mm wall thickness, 133.7-kPa elastic modulus). B-mode imaging confirmed the difference in thickness between the lesion segment and flank segments of the phantom. Also, Doppler-based vessel wall displacement analysis revealed that when pulsatile flow was fed through the phantom (carotid pulse; 27 mL/s peak flow rate), the lesion segment distended less compared with the flank segments. Specifically, the three-beat averaged peak wall displacement in the lesion segment was measured as 0.28 mm, and it was significantly smaller than that of the flank segments (0.60 mm). It is anticipated that this new multi-segment arterial phantom can serve as a performance testbed for the evaluation of local arterial stiffness estimation algorithms.

Receiver-Operating Characteristic Analysis of Eigen-Based Clutter Filters for Ultrasound Color Flow Imaging

The eigen-based filter has theoretically established itself as a potent solution in ultrasound color flow imaging (CFI) for combating against clutter arising from moving tissues. Yet, it remains poorly understood on how much gain in flow detection sensitivity and specificity can be delivered by this adaptive clutter filter. Here, we investigated the receiver operating characteristic (ROC) of the eigen-based clutter filter to statistically evaluate its efficacy. Our investigation was conducted using a new vascular phantom testbed that incorporated both intrinsic tissue motion (vessel pulsation: 7.58 cm/s peak velocity) and extrinsic tissue motion (vibration: 5-Hz frequency, 2.98 cm/s peak velocity), as well as pulsatile flow (pulse rate: 60 beats/min; systolic flow rate: 6.5 mL/s). The eigen-filter (single-ensemble formulation) was applied to CFI raw data sets obtained from the phantom's short-axis view (slow-time ensemble size: 12; pulse repetition frequency: 2 kHz; and ultrasound frequency: 5 MHz), and post-filter Doppler power was compared between flow and tissue regions. Results show that, in the presence of vessel pulsation and tissue vibration, the eigen-filter yielded a high true positive rate in depicting flow pixels in CFI frames (0.945 and 0.917, respectively, during peak systole and end diastole at 60° beam-flow angle), while maintaining a low false alarm rate (0.10) in rendering tissue pixels. Also, the eigen-filter posed ROC curves whose area under curve was higher than those for the polynomial regression filter (statistically significant; t-test p values were less than 0.05). These findings serve well to substantiate the merit of using eigen-filters to enhance the vascular visualization capability of CFI.

Spiral Flow Phantom for Ultrasound Flow Imaging Experimentation

As new ultrasound flow imaging methods are being developed, there is a growing need to devise appropriate flow phantoms that can holistically assess the accuracy of the derived flow estimates. In this paper, we present a novel spiral flow phantom design whose Archimedean spiral lumen naturally gives rise to multi-directional flow over all possible angles (i.e., from 0° to 360°). Developed using lost-core casting principles, the phantom geometry comprised a three-loop spiral (4-mm diameter and 5-mm pitch), and it was set to operate in steady flow mode (3 mL/s flow rate). After characterizing the flow pattern within the spiral vessel using computational fluid dynamics (CFD) simulations, the phantom was applied to evaluate the performance of color flow imaging (CFI) and high-frame-rate vector flow imaging. Significant spurious coloring artifacts were found when using CFI to visualize flow in the spiral phantom. In contrast, using vector flow imaging (least-squares multi-angle Doppler based on a three-transmit and three-receive configuration), we observed consistent depiction of flow velocity magnitude and direction within the spiral vessel lumen. The spiral flow phantom was also found to be a useful tool in facilitating demonstration of dynamic flow visualization based on vector projectile imaging. Overall, these results demonstrate the spiral flow phantom's practical value in analyzing the efficacy of ultrasound flow estimation methods.

A GPU-Parallelized Eigen-Based Clutter Filter Framework for Ultrasound Color Flow Imaging

Eigen-filters with attenuation response adapted to clutter statistics in color flow imaging (CFI) have shown improved flow detection sensitivity in the presence of tissue motion. Nevertheless, its practical adoption in clinical use is not straightforward due to the high computational cost for solving eigendecompositions. Here, we provide a pedagogical description of how a real-time computing framework for eigen-based clutter filtering can be developed through a single-instruction, multiple data (SIMD) computing approach that can be implemented on a graphical processing unit (GPU). Emphasis is placed on the single-ensemble-based eigen-filtering approach (Hankel singular value decomposition), since it is algorithmically compatible with GPU-based SIMD computing. The key algebraic principles and the corresponding SIMD algorithm are explained, and annotations on how such algorithm can be rationally implemented on the GPU are presented. Real-time efficacy of our framework was experimentally investigated on a single GPU device (GTX Titan X), and the computing throughput for varying scan depths and slow-time ensemble lengths was studied. Using our eigen-processing framework, real-time video-range throughput (24 frames/s) can be attained for CFI frames with full view in azimuth direction (128 scanlines), up to a scan depth of 5 cm ( λ pixel axial spacing) for slow-time ensemble length of 16 samples. The corresponding CFI image frames, with respect to the ones derived from non-adaptive polynomial regression clutter filtering, yielded enhanced flow detection sensitivity in vivo, as demonstrated in a carotid imaging case example. These findings indicate that the GPU-enabled eigen-based clutter filtering can improve CFI flow detection performance in real time.

Wall-Less Flow Phantoms With Tortuous Vascular Geometries: Design Principles and a Patient-Specific Model Fabrication Example

Flow phantoms with anatomically realistic geometry and high acoustic compatibility are valuable investigative tools in vascular ultrasound studies. Here, we present a new framework to fabricate ultrasound-compatible flow phantoms to replicate human vasculature that is tortuous, nonplanar, and branching in nature. This framework is based upon the integration of rapid prototyping and investment casting principles. A pedagogical walkthrough of our engineering protocol is presented in this paper using a patient-specific cerebral aneurysm model as an exemplar demonstration. The procedure for constructing the flow circuit component of the phantoms is also presented, including the design of a programmable flow pump system, the fabrication of blood mimicking fluid, and flow rate calibration. Using polyvinyl alcohol cryogel as the tissue mimicking material, phantoms developed with the presented protocol exhibited physiologically relevant acoustic properties [attenuation coefficient: 0.229±0.032 dB/( [Formula: see text]) and acoustic speed: 1535±2.4 m/s], and their pulsatile flow dynamics closely resembled the flow profile input. As a first application of our developed phantoms, the flow pattern of the patient-specific aneurysm model was visualized by performing high-frame-rate color-encoded speckle imaging over multiple time-synchronized scan planes. Persistent recirculation was observed, and the vortex center was found to shift in position over a cardiac cycle, indicating the 3-D nature of flow recirculation inside an aneurysm. These findings suggest that phantoms produced from our reported protocol can serve well as acoustically compatible test beds for vascular ultrasound studies, including 3-D flow imaging.