Low-cost Volumetric Ultrasound by Augmentation of 2D Systems: Design and Prototype

IMU-Assisted Manual 3D-Ultrasound Imaging Using Motion-Constrained Swept-Fan Scans

Three-dimensional (3D) ultrasonic imaging can enable post-facto plane of interest selection. It can be performed with devices such as wobbler probes, matrix probes, and sensor-based probes. Ultrasound systems that support 3D-imaging are expensive with added hardware complexity compared to 2D-imaging systems. An inertial measurement unit (IMU) can potentially be used for 3D-imaging by using it to track the motion of a one-dimensional array probe and constraining its motion in one degree of freedom (1-DoF) rotation (swept-fan). This work demonstrates the feasibility of an affordable IMU-assisted manual 3D-ultrasound scanner (IAM3US). A consumer-grade IMU-assisted 3D scanner prototype is designed with two support structures for swept-fan. After proper IMU calibration, an appropriate KF-based algorithm estimates the probe orientation during the swept-fan. An improved scanline-based reconstruction method is used for volume reconstruction. The evaluation of the IAM3US system is done by imaging a tennis ball filled with water and the head region of a fetal phantom. From fetal phantom reconstructed volumes, suitable 2D planes are extracted for biparietal diameter (BPD) manual measurements. Later, in-vivo data is collected. The novel contributions of this paper are (1) the application of a recently proposed algorithm for orientation estimation of swept-fan for 3D imaging, chosen based on the noise characteristics of selected consumer grade IMU (2) assessment of the quality of the 1-DoF swept-fan scan with a deflection detector along with monitoring of maximum angular rate during the scan and (3) two probe holder designs to aid the operator in performing the 1-DoF rotational motion and (4) end-to-end 3D-imaging system-integration. Phantom studies and preliminary in-vivo obstetric scans performed on two patients illustrate the usability of the system for diagnosis purposes.

Accuracy and Feasibility of Three-Dimensional Ultrasound Testing in Eye Clinic and Emergency Department Patients with Vision Complaints

BACKGROUND

Ocular emergencies comprise 2-3% of emergency department (ED) visits, with retinal detachment requiring emergency surgery. Two-dimensional ultrasound is a rapid bedside tool but is highly operator dependent.

OBJECTIVE

We determined three-dimensional ultrasound (3DUS) feasibility, acceptability, and usability in eye pathology detection using the ophthalmologist examination as reference standard.

METHODS

We performed a prospective, blinded cohort study of a 3DUS-enabling device in 30 eye clinic and ED patients with visual symptoms and calculated 3DUS performance characteristics. Two expert readers interpreted the 3DUS images for pathology. All participants completed surveys.

RESULTS

3DUS sensitivity was 0.81, specificity 0.73, positive predictive value 0.54, negative predictive value 0.91, and likelihood ratio (LR)+/LR- 3.03 and 0.26, respectively. Novice and expert sonographers had "substantial" agreement in correct diagnosis of abnormal vs. normal (κ = 0.68, 95% confidence interval 0.48-0.88). Most patients indicated that 3DUS is fast, comfortable, helps them understand their problem, and improves provider interaction/care, and all sonographers agreed; 4/5 sonographers felt confident performing ultrasound. Expert readers correctly identified an abnormal eye in 83/120 scans (76%) and correct diagnosis in 72/120 scans (65%), with no statistical difference between novice (79%; 69%) and expert (72%; 61%) sonographers (p = 0.39, p = 0.55), suggesting reduced operator dependence. Reader diagnosis confidence and image quality varied widely. Image acquisition times were fast for novice (mean 225 ± 83 s) and expert (201 ± 51) sonographers, with fast expert reader interpretation times (225 ± 136).

CONCLUSIONS

A 3DUS-enabling device demonstrates a sensitivity of 0.81 and specificity of 0.73 for disease detection, fast image acquisition, and may reduce operator dependence for detecting emergent retinal pathologies. Further technological development is needed to improve diagnostic accuracy in identifying and characterizing retinal pathology.

Development of an ultrasound guided focused ultrasound system for 3D volumetric low energy nanodroplet-mediated histotripsy

Low pressure histotripsy is likely to facilitate current treatments that require extremely high pressures. An ultrasound guided focused ultrasound system was designed to accommodate a rotating imaging transducer within a low frequency therapeutic transducer that operates at a center frequency of 105 kHz. The implementation of this integrated system provides real-time therapeutic and volumetric imaging functions, that are used here for low-cost, low-energy 3D volumetric ultrasound histotripsy using nanodroplets. A two-step approach for low pressure histotripsy is implemented with this dual-array. Vaporization of nanodroplets into gaseous microbubbles was performed via the 1D rotating imaging probe. The therapeutic transducer is then used to detonate the vaporized nanodroplets and trigger potent mechanical effects in the surrounding tissue. Rotating the imaging transducer creates a circular vaporized nanodroplet shape which generates a round lesion upon detonation. This contrasts with the elongated lesion formed when using a standard 1D imaging transducer for nanodroplet activation. Optimization experiments show that maximal nanodroplet activation can be achieved with a 2-cycle excitation pulse at a center frequency of 3.5 MHz, and a peak negative pressure of 3.4 MPa (a mechanical index of 1.84). Vaporized nanodroplet detonation was achieved by applying a low frequency treatment at a center frequency of 105 kHz and mechanical index of 0.9. In ex-vivo samples, the rotated nanodroplet activation method yielded the largest lesion area, with a mean of 4.7 ± 0.5 mm², and a rounded shape. In comparison, standard fixed transducer nanodroplet activation resulted in an average lesion area of 2.6 ± 0.4 mm², and an elongated shape. This hybrid system enables to achieve volumetric low energy histotripsy, and thus facilitates the creation of precise, large-volume mechanical lesions in tissues, while reducing the pressure threshold required for standard histotripsy by over an order of magnitude.

Recent Advances in Tracking Devices for Biomedical Ultrasound Imaging Applications

With the rapid advancement of tracking technologies, the applications of tracking systems in ultrasound imaging have expanded across a wide range of fields. In this review article, we discuss the basic tracking principles, system components, performance analyses, as well as the main sources of error for popular tracking technologies that are utilized in ultrasound imaging. In light of the growing demand for object tracking, this article explores both the potential and challenges associated with different tracking technologies applied to various ultrasound imaging applications, including freehand 3D ultrasound imaging, ultrasound image fusion, ultrasound-guided intervention and treatment. Recent development in tracking technology has led to increased accuracy and intuitiveness of ultrasound imaging and navigation with less reliance on operator skills, thereby benefiting the medical diagnosis and treatment. Although commercially available tracking systems are capable of achieving sub-millimeter resolution for positional tracking and sub-degree resolution for orientational tracking, such systems are subject to a number of disadvantages, including high costs and time-consuming calibration procedures. While some emerging tracking technologies are still in the research stage, their potentials have been demonstrated in terms of the compactness, light weight, and easy integration with existing standard or portable ultrasound machines.

Improving plane wave ultrasound imaging through real-time beamformation across multiple arrays

Ultrasound imaging is a widely used diagnostic tool but has limitations in the imaging of deep lesions or obese patients where the large depth to aperture size ratio (f-number) reduces image quality. Reducing the f-number can improve image quality, and in this work, we combined three commercial arrays to create a large imaging aperture of 100 mm and 384 elements. To maintain the frame rate given the large number of elements, plane wave imaging was implemented with all three arrays transmitting a coherent wavefront. On wire targets at a depth of 100 mm, the lateral resolution is significantly improved; the lateral resolution was 1.27 mm with one array (1/3 of the aperture) and 0.37 mm with the full aperture. After creating virtual receiving elements to fill the inter-array gaps, an autoregressive filter reduced the grating lobes originating from the inter-array gaps by − 5.2 dB. On a calibrated commercial phantom, the extended field-of-view and improved spatial resolution were verified. The large aperture facilitates aberration correction using a singular value decomposition-based beamformer. Finally, after approval of the Stanford Institutional Review Board, the three-array configuration was applied in imaging the liver of a volunteer, validating the potential for enhanced resolution.

Accuracy Report on a Handheld 3D Ultrasound Scanner Prototype Based on a Standard Ultrasound Machine and a Spatial Pose Reading Sensor

The aim of this study was to develop and evaluate a 3D ultrasound scanning method. The main requirements were the freehand architecture of the scanner and high accuracy of the reconstructions. A quantitative evaluation of a freehand 3D ultrasound scanner prototype was performed, comparing the ultrasonographic reconstructions with the CAD (computer-aided design) model of the scanned object, to determine the accuracy of the result. For six consecutive scans, the 3D ultrasonographic reconstructions were scaled and aligned with the model. The mean distance between the 3D objects ranged between 0.019 and 0.05 mm and the standard deviation between 0.287 mm and 0.565 mm. Despite some inherent limitations of our study, the quantitative evaluation of the 3D ultrasonographic reconstructions showed comparable results to other studies performed on smaller areas of the scanned objects, demonstrating the future potential of the developed prototype.

3-D Endoluminal Ultrasound Biomicroscopic Imaging and Volumetry of Mouse Colon Tumors

Currently, colonoscopy is considered the gold standard procedure for diagnosis of colorectal cancer (CRC), the third most common cancer in the United States. However, this technique fails to detect flat adenomas, serrated polyps and advanced adenomas, with miss rates of 34%, 27% and 14%, respectively. These miss rates, more frequent than previously supposed, suggest the need for new CRC screening tools. In the work described here, the potential application of a 40-MHz ultrasound system to generate a sequence of 2-D endoluminal ultrasound biomicroscopy (eUBM-2-D) images of a mouse model of colon cancer was investigated, and this image sequence was used to render eUBM-3-D images and to measure tumor volume. The technique was validated with tissue-mimicking phantoms and used in vivo with mice bearing colon polypoid tumors. Estimated volumes ranged from 0.174-7.909 mm³ for targets in validation phantoms and from 0.066-6.082 mm³ for mouse colon tumors.

Versatile Low-Cost Volumetric 3D Ultrasound Imaging Using Gimbal-Assisted Distance Sensors and an Inertial Measurement Unit

This study aims at creating low-cost, three-dimensional (3D), freehand ultrasound image reconstructions from commercial two-dimensional (2D) probes. The low-cost system that can be attached to a commercial 2D ultrasound probe consists of commercial ultrasonic distance sensors, a gimbal, and an inertial measurement unit (IMU). To calibrate irregular movements of the probe during scanning, relative position data were collected from the ultrasonic sensors that were attached to a gimbal. The directional information was provided from the IMU. All the data and 2D ultrasound images were combined using a personal computer to reconstruct 3D ultrasound image. The relative position error of the proposed system was less than 0.5%. The overall shape of the cystic mass in the breast phantom was similar to those from 2D and sections of 3D ultrasound images. Additionally, the pressure and deformations of lesions could be obtained and compensated by contacting the probe to the surface of the soft tissue using the acquired position data. The proposed method did not require any initial marks or receivers for the reconstruction of a 3D ultrasound image using a 2D ultrasound probe. Even though our system is less than $500, a valuable volumetric ultrasound image could be provided to the users.

Three-dimensional view of out-of-plane artifacts in photoacoustic imaging using a laser-integrated linear-transducer-array probe

Research on photoacoustic imaging (PAI) using a handheld integrated photoacoustic probe has been a recent focus of clinical translation of this imaging technique. One of the remaining challenges is the occurrence of out-of-plane artifacts (OPAs) in such a probe. Previously, we proposed a method to identify and remove OPAs by axially displacing the transducer array. Here we show that besides the benefit of removing OPAs from the imaging plane, the proposed method can provide a three-dimensional (3D) view of the OPAs. In this work, we present a 3D reconstruction method using axial transducer array displacement. By axially displacing the transducer array, out-of-plane absorbers can be three-dimensionally visualized at an elevation distance of up to the acquired imaging depth. Additionally, OPAs in the in-plane image are significantly reduced. We experimentally demonstrate the method with phantom and in vivo experiments using an integrated PAI probe. We also compare the method with elevational transducer array displacement and take into account the sensitivity of the transducer array in the 3D reconstruction.

A prospective blinded comparison of second trimester fetal measurements by expert and novice readers using low-cost novice-acquired 3D volumetric ultrasound

RATIONALE AND OBJECTIVES

Two-dimensional (2D) ultrasound (US) is operator dependent, requiring operator skill and experience to selectively identify and record planes of interest for subsequent interpretation. This limits the utility of US in settings in which expert sonographers are unavailable. Three-dimensional (3D) US acquisition of an anatomic target, which enables reconstruction of any plane through the acquired volume, might reduce operator dependence by providing any desired image plane for interpretation, without identification of target planes of interest at the time of acquisition. We applied a low-cost 3DUS technology because of the wider potential application compared with dedicated 3DUS systems. We chose second trimester fetal biometric parameters for study because of their importance in maternal-fetal health globally. We hypothesized that expert and novice interpretations of novice-acquired 3D volumes would not differ from each other nor from expert measurements of expert-acquired 2D images, the clinical reference standard.

MATERIALS AND METHODS

This was a prospective, blinded, observational study. Expert sonographers blinded to 3DUS volumes acquired 2DUS images of second trimester fetuses from 32 subjects, and expert readers performed interpretation, during usual care. A novice sonographer blinded to other clinical data acquired oriented 3DUS image volumes of the same subjects on the same date. Expert readers blinded to other data assessed placental location (PL), fetal presentation (FP), and amniotic fluid volume (AFV) in novice-acquired 3D volumes. Novice and expert raters blinded to other data independently measured biparietal diameter (BPD), humerus length (HL), and femur length (FL) for each fetus from novice-acquired 3D volumes. Corresponding gestational age (GA) estimates were calculated. Inter-rater reliability of measurements and GAs (expert 3D versus expert 2D, novice 3D versus expert 2D, and expert 3D versus novice 3D) were assessed by intraclass correlation coefficient (ICC). Mean inter-rater measurement differences were analyzed using one-way ANOVA.

RESULTS

3D volume acquisition and reconstruction required mean 30.4 s (±5.7) and 70.0 s (±24.0), respectively. PL, FP, and AFV were evaluated from volumes for all subjects; mean time for evaluation was 16 s (±0.0). PL, FP, and AFV could be evaluated for all subjects. At least one biometric measurement was possible for 31 subjects (97%). Agreement between rater pairs for a composite of all measures was excellent (ICCs ≥ 0.95), and for individual measures was good to excellent (ICCs ≥ 0.75). Inter-rater differences were not significant (p > .05).

CONCLUSIONS

Expert and novice interpretations of novice-acquired 3DUS volumes of second trimester fetuses provided reliable biometric measures compared with expert interpretation of expert-acquired 2DUS images. 3DUS volume acquisition with a low-cost system may reduce operator dependence of ultrasound.

Reducing artifacts in photoacoustic imaging by using multi-wavelength excitation and transducer displacement

The occurrence of artifacts is a major challenge in photoacoustic imaging. The artifacts negatively affect the quality and reliability of the images. An approach using multi-wavelength excitation has previously been reported for in-plane artifact identification. Yet, out-of-plane artifacts cannot be tackled with this method. Here we propose a new method using ultrasound transducer array displacement. By displacing the ultrasound transducer array axially, we can de-correlate out-of-plane artifacts with in-plane image features and thus remove them. Combining this new method with the previous one allows us to remove potentially completely both in-plane and out-of-plane artifacts in photoacoustic imaging. We experimentally demonstrate this with experiments in phantoms as well as in vivo.

Versatile Low-Cost Volumetric 3-D Ultrasound Platform for Existing Clinical 2-D Systems

Ultrasound imaging has indications across many areas of medicine, but the need for training and the variability in skill and acquired image quality among 2-D ultrasound users have limited its wider adoption and utilization. Low-cost volumetric ultrasound with a known frame of reference has the potential to lower these operator-dependent barriers and enhance the clinical utility of ultrasound imaging. In this paper, we improve upon our previous research-scanner-based prototype to implement a versatile volumetric imaging platform for existing clinical 2-D ultrasound systems. We present improved data acquisition and image reconstruction schemes to increase quality, streamline workflow, and provide real-time visual feedback. We present initial results using the platform on a Vimedix simulator, as well as on phantom and in vivo targets using a variety of clinical ultrasound systems and probes.