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Lee CU, Urban MW, Hesley GK, Wood BG, Meier TR, Chen B, Kassmeyer BA, Larson NB, Lee Miller A, Herrick JL, Jakub JW, Piltin MA. Long-Term Ultrasound Twinkling Detectability and Safety of a Polymethyl Methacrylate Soft Tissue Marker Compared to Conventional Breast Biopsy Markers-A Preclinical Study in a Porcine Model. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1001-1009. [PMID: 38575416 DOI: 10.1016/j.ultrasmedbio.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/21/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE We have studied the use of polymethyl methacrylate (PMMA) as an alternative biopsy marker that is readily detectable with ultrasound Doppler twinkling in cases of in vitro, ex vivo, or limited duration in vivo settings. This study investigates the long-term safety and ultrasound Doppler twinkling detectability of a PMMA breast biopsy marker following local perturbations and different dwell times in a 6-mo animal experiment. METHODS This study, which was approved by our Institutional Animal Care and Use Committee, involved three pigs and utilized various markers, including PMMA (Zimmer Biomet), 3D-printed, and Tumark Q markers. Markers were implanted at different times for each pig. Mesh material or ethanol was used to induce a local inflammatory reaction near certain markers. A semiquantitative twinkling score assessed twinkling for actionable localization during monthly ultrasounds. At the primary endpoint, ultrasound-guided localization of lymph nodes with detectable markers was performed. Following surgical resection of the localized nodes, histomorphometric analysis was conducted to evaluate for tissue ingrowth and the formation of a tissue rind around the markers. RESULTS No adverse events occurred. Twinkling scores of all markers for all three pigs decreased gradually over time. The Q marker exhibited the highest mean twinkling score followed by the PMMA marker, PMMA with mesh, and Q with ethanol. The 3D-printed marker with mesh and PMMA with ethanol had the lowest scores. All wire-localized lymph nodes were successfully resected. Despite varying percentages of tissue rind around the markers and a significant reduction in overall twinkling (p < 0.001) over time, mean PMMA twinkling scores remained clinically actionable at 6 and 5 mo using a General Electric C1-6 probe and 9L-probe, respectively. CONCLUSIONS In this porcine model, the PMMA marker demonstrates an acceptable safety profile. Clinically actionable twinkling aids PMMA marker detection even after 6 mo of dwell time in porcine lymph nodes. The Q marker maintained the greatest twinkling over time compared to all the other markers studied.
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Affiliation(s)
- Christine U Lee
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, Rochester, MD, USA.
| | - Matthew W Urban
- Department of Radiology, Division of Radiology Research, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MD, USA
| | - Gina K Hesley
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, Rochester, MD, USA
| | | | - Thomas R Meier
- Department of Comparative Medicine, Mayo Clinic, Rochester, MD, USA
| | - Beiyun Chen
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MD, USA
| | - Blake A Kassmeyer
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MD, USA
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MD, USA
| | - A Lee Miller
- Biomaterials and Histomorphometry Core, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MD, USA
| | - James L Herrick
- Biomaterials and Histomorphometry Core, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MD, USA
| | - James W Jakub
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL USA
| | - Mara A Piltin
- Department of Surgery, Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MD, USA
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Zhao Y, Czarnota GJ, Park TH, Miller RJ, Oelze ML. In Vivo Validation of an In Situ Calibration Bead as a Reference for Backscatter Coefficient Calculation. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:833-842. [PMID: 38471999 DOI: 10.1016/j.ultrasmedbio.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE The study described here was aimed at assessing the capability of quantitative ultrasound (QUS) based on the backscatter coefficient (BSC) for classifying disease states, such as breast cancer response to neoadjuvant chemotherapy and quantification of fatty liver disease. We evaluated the effectiveness of an in situ titanium (Ti) bead as a reference target in calibrating the system and mitigating attenuation and transmission loss effects on BSC estimation. METHODS Traditional BSC estimation methods require external references for calibration, which do not account for ultrasound attenuation or transmission losses through tissues. To address this issue, we used an in situ Ti bead as a reference target, because it can be used to calibrate the system and mitigate the attenuation and transmission loss effects on estimation of the BSC. The capabilities of the in situ calibration approach were assessed by quantifying consistency of BSC estimates from rabbit mammary tumors (N = 21). Specifically, mammary tumors were grown in rabbits and when a tumor reached ≥1 cm in size, a 2 mm Ti bead was implanted in the tumor as a radiological marker and a calibration source for ultrasound. Three days later, the tumors were scanned with an L-14/5 38 array transducer connected to a SonixOne scanner with and without a slab of pork belly placed on top of the tumors. The pork belly acted as an additional source of attenuation and transmission loss. QUS parameters, specifically effective scatterer diameter (ESD) and effective acoustic concentration (EAC), were calculated using calibration spectra from both an external reference phantom and the Ti bead. RESULTS For ESD estimation, the 95% confidence interval between measurements with and without the pork belly layer was 6.0, 27.4 using the in situ bead and 114, 135.1 with the external reference phantom. For EAC estimation, the 95% confidence intervals were -8.1, 0.5 for the bead and -41.5, -32.2 for the phantom. These results indicate that the in situ bead method has reduced bias in QUS estimates because of intervening tissue losses. CONCLUSION The use of an in situ Ti bead as a radiological marker not only serves its traditional role but also effectively acts as a calibration target for QUS methods. This approach accounts for attenuation and transmission losses in tissue, resulting in more accurate QUS estimates and offering a promising method for enhanced disease state classification in clinical settings.
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Affiliation(s)
- Yuning Zhao
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Gregory J Czarnota
- Department of Medical Biophysics and Radiation Oncology, University of Toronto, Toronto, ON, Canada; Department of Imaging Research and Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Rita J Miller
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Michael L Oelze
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Wood BG, Saracaydin R, Hara SA, Lee CU, Urban MW. Using 3-D-Printed Structures to Evaluate the Potential Causes of the Color Doppler Twinkling Signature. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:671-679. [PMID: 38331697 PMCID: PMC10977030 DOI: 10.1016/j.ultrasmedbio.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The color Doppler twinkling artifact has been attributed to existing microbubbles or cavitation occurring on rough objects such as kidney stones, some breast biopsy clips, catheter guidewires and sandpaper. The objective was to investigate the correlation between the surface characteristics of helical constructs with different groove geometries and the occurrence of twinkling, as well as to identify locations conducive to bubble retention and/or cavitation. METHODS Six half-cylinders were created with a microscale 3-D printer with 5 µm resolution to replicate the geometry of twinkling helical constructs resembling catheter guidewires. Four copies of each marker including a non-twinkling control were printed. The half-cylinders had pitch (peak-to-peak distance) values ranging from 87.5 to 343 µm and amplitude (groove depth) values ranging from 41.5 to 209 µm. The half-cylinders were submerged in degassed water and optically imaged before and after ultrasound insonification to visualize bubbles on the cylinders. The cylinders remained submerged while scanning with the color Doppler mode at frequencies from 3.1 to 6.3 MHz using a GE Logiq E9 scanner and 9L linear array transducer. RESULTS Two markers exhibited twinkling: one with pitch-to-amplitude ratio of 174/210 µm/µm (0.8) that twinkled only with pre-existing bubbles on the marker; the other had a ratio of 87/87 µm/µm (1.00) that twinkled without pre-existing bubbles on the marker. CONCLUSION This work provides strong evidence that both existing bubbles and either cavitation or ultrasound wave interactions with patterned or rough surfaces are significant factors in producing the twinkling signature.
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Affiliation(s)
- Benjamin G Wood
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA.
| | | | - Seth A Hara
- Division of Engineering, Mayo Clinic, Rochester, MN, USA
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Dupere JM, Brost EE, Uthamaraj S, Lee CU, Urban MW, Stish BJ, Deufel CL. A new way to visualize prostate brachytherapy needles using ultrasound color Doppler and needle surface modifications. Brachytherapy 2023; 22:761-768. [PMID: 37652777 DOI: 10.1016/j.brachy.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Suboptimal ultrasound conspicuity of the brachytherapy applicator can lead to inaccurate image reconstructions of the applicator resulting in decreased tumor control or increased normal tissue dose. This feasibility study aims to improve ultrasound conspicuity of high-dose rate (HDR) brachytherapy needles by modifying the surface of the needles to produce a color Doppler twinkling signature. MATERIALS AND METHODS Surface modifications of standard 17-gauge titanium HDR brachytherapy needles included laser-scribing, application of polymethyl methacrylate (PMMA), and coating with a commercially available echogenic coating. Laser-scribing was performed with variable widths (0.1-1 mm) and depths (10-100 μm). The echogenic coating was applied with 3 different thicknesses (27, 40, and 64 μm). Unmodified and modified needles were imaged under B-mode and color Doppler ultrasound in phantom and cadaver, and the signal strength was recorded. RESULTS Laser-scribed, PMMA-coated, and echogenic-coated brachytherapy needles produced a twinkling signature along the needle shaft on color Doppler ultrasound. Twinkling was observed with laser-scribe depths >20 μm and widths >0.1 mm and from echogenic coatings 40 μm and 64 μm thick. Twinkling was not observed with unmodified needles. The twinkling signature had a spectral composition with a uniform magnitude between the velocities of 2 to 16 cm/s. CONCLUSIONS Color Doppler ultrasound of surface-modified brachytherapy applicators may improve applicator conspicuity aiding applicator placement and digitization. HDR brachytherapy needles may be modified to produce the twinkling signature via laser-scribing, PMMA rings, or applying an echogenic coating.
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Affiliation(s)
| | - Eric E Brost
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | | | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Lee CU, Piltin MA, Moldoveanu D, Urban MW, Hesley GK. Using US Twinkling Artifact to Identify Breast Biopsy Markers: Brief Report. Radiol Imaging Cancer 2023; 5:e220168. [PMID: 37326508 PMCID: PMC10413298 DOI: 10.1148/rycan.220168] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/08/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
Breast biopsy markers play an essential role in the surgical management of patients with clinically node-positive breast cancer. Marking a pathology-proven lymph node ensures accurate imaging assessment of response to neoadjuvant systemic therapy and decreased false-negative rates in sentinel lymph node biopsy. There is a clinically unmet need to make breast biopsy markers, particularly in the axilla, more sonographically visible or identifiable for preoperative localization purposes. Previously described color Doppler US twinkling artifact of some breast biopsy markers in in vitro gel phantoms and in ex vivo cadaveric breasts suggests that twinkling of such markers can be leveraged for improved in vivo detection. In this retrospective case series of eight female patients (mean age, 58.6 years ± 12.3 [SD]), conventional B-mode US imaging failed to identify the biopsy marker associated with a surgical target in the breast or in an axillary lymph node. However, in each patient, the marker was successfully identified with the help of color Doppler US twinkling. Keywords: Breast, Ultrasound, Color Doppler US, Lymphatic, Artifacts, Biopsy Marker Published under a CC BY 4.0 license.
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Affiliation(s)
- Christine U. Lee
- From the Department of Radiology, Division of Breast Imaging and
Intervention (C.U.L., G.K.H.), Department of Surgery, Division of Breast and
Melanoma Surgical Oncology (M.A.P., D.M.), Department of Radiology, Division of
Radiology Research (M.W.U.), and Department of Physiology and Biomedical
Engineering (M.W.U.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Mara A. Piltin
- From the Department of Radiology, Division of Breast Imaging and
Intervention (C.U.L., G.K.H.), Department of Surgery, Division of Breast and
Melanoma Surgical Oncology (M.A.P., D.M.), Department of Radiology, Division of
Radiology Research (M.W.U.), and Department of Physiology and Biomedical
Engineering (M.W.U.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Dan Moldoveanu
- From the Department of Radiology, Division of Breast Imaging and
Intervention (C.U.L., G.K.H.), Department of Surgery, Division of Breast and
Melanoma Surgical Oncology (M.A.P., D.M.), Department of Radiology, Division of
Radiology Research (M.W.U.), and Department of Physiology and Biomedical
Engineering (M.W.U.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Matthew W. Urban
- From the Department of Radiology, Division of Breast Imaging and
Intervention (C.U.L., G.K.H.), Department of Surgery, Division of Breast and
Melanoma Surgical Oncology (M.A.P., D.M.), Department of Radiology, Division of
Radiology Research (M.W.U.), and Department of Physiology and Biomedical
Engineering (M.W.U.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Gina K. Hesley
- From the Department of Radiology, Division of Breast Imaging and
Intervention (C.U.L., G.K.H.), Department of Surgery, Division of Breast and
Melanoma Surgical Oncology (M.A.P., D.M.), Department of Radiology, Division of
Radiology Research (M.W.U.), and Department of Physiology and Biomedical
Engineering (M.W.U.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Editor's Notebook: March 2023. AJR Am J Roentgenol 2023; 220:312-313. [PMID: 36812300 DOI: 10.2214/ajr.22.28839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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