Assessing lung aeration using ultrasound after birth in near-term lambs at risk of respiratory distress

Background

Optimizing respiratory support after birth requires real-time feedback on lung aeration. We hypothesized that lung ultrasound (LUS) can accurately monitor the extent and progression of lung aeration after birth and is closely associated with oxygenation.

Methods

Near-term (140 days gestation, term ∼147 days), spontaneously breathing lambs with normal (controls; n = 10) or elevated lung liquid levels (EL; n= 9) were delivered by Caesarean section and monitored for four hours after birth. LUS (Phillips CX50, L3-12 transducer) images and arterial blood gases were taken every 5-20 min. LUS images were analyzed both qualitatively (grading) and quantitatively (using the coefficient of variation of pixel intensity (CoV) to estimate the degree of lung aeration), which was correlated with the oxygen exchange capacity of the lungs (Alveolar-arterial difference in oxygen; AaDO₂).

Results

Lung aeration, measured using LUS, and the AaDO₂ improved over the first 4 h after birth. The increase in lung aeration measured using CoV of pixel intensity, but not LUS grade, was significantly reduced in EL lambs compared to controls (p = 0.02). The gradual decrease in AaDO₂ after birth was significantly correlated with increased lung aeration in both control (grade, r²= 0.60, p < 0.0001; CoV, r²= 0.54, p < 0.0001) and EL lambs (grade, r²= 0.51, p < 0.0001; CoV, r²= 0.44, p < 0.0001).

Conclusions

LUS can monitor lung aeration and liquid clearance after birth in spontaneously breathing near-term lambs. Image analysis techniques (CoV) may be able detect small to moderate differences in lung aeration in conditions with lung liquid retention which are not readily identified using qualitative LUS grading.

Tomographic reconstruction using tilted Laue analyser-based X-ray phase-contrast imaging

Analyser-based phase-contrast imaging (ABPCI) is a highly sensitive phase-contrast imaging method that produces high-contrast images of weakly absorbing materials. However, it is only sensitive to phase gradient components lying in the diffraction plane of the analyser crystal [i.e. in one dimension (1-D)]. In order to accurately account for and measure phase effects produced by the wavefield-sample interaction, ABPCI and other 1-D phase-sensitive methods must achieve 2-D phase gradient sensitivity. An inclined geometry method was applied to a Laue geometry setup for X-ray ABPCI through rotation of the detector and object about the optical axis. This allowed this traditionally 1-D phase-sensitive phase-contrast method to possess 2-D phase gradient sensitivity. Tomographic datasets were acquired over 360° of a multi-material phantom with the detector and sample tilted by 8°. The real and imaginary parts of the refractive index were reconstructed for the phantom.

Decoding the structure of granular and porous materials from speckled phase contrast X-ray images

Imaging techniques for studying the structure of opaque, granular and porous materials are limited by temporal resolution and radiation dose. We present a technique for characterising the structure of such materials by decoding three dimensional structural information from single, propagation based phase contrast X-ray images. We demonstrate the technique by measuring the distribution of diameters of glass microspheres in packed samples. We also present synthetic data, which shows that our inverse method is stable and that accuracy is improved by phase contrast X-ray imaging. Compared to computed tomography, our technique has superior temporal resolution and lower radiation dose.

Single-exposure dual-energy-subtraction X-ray imaging using a synchrotron source

Projection radiography of the chest has long been plagued by the presence of bony anatomy obscuring visibility of the lungs and heart. Dual-energy subtraction is a well known method for differentiating bone and soft tissue, but existing techniques are not ideally suited to dynamic imaging. Herein a new technique to address this problem is presented. The harmonic content of a monochromated X-ray beam is exploited, and two in-line detectors are used to perform single-exposure dual-energy imaging. Images of a phantom demonstrate the ability to both separate and quantitatively measure the thickness of constituent materials, whilst images of a mouse thorax demonstrate the ability to separate bone and soft tissue in a biological specimen. The technique is expected to improve the performance of dynamic lung imaging.

Determining particle size distributions from a single projection image

Imaging techniques employed to measure the structure of granular, particulate and porous materials are limited by scale, temporal resolution and, for biological samples, radiation exposure. This paper describes a technique for determining the distribution of particle sizes in opaque samples, for particle volume fractions less than ten percent, using a single projection radiograph. The method is based on the derived property of the additivity of the particles' spatial autocorrelation function in projection images. Simulations and experiments demonstrate the ability to use this property to determine the distribution of particle sizes in a material.

Interface-specific x-ray phase retrieval tomography of complex biological organs

We demonstrate interface-specific propagation-based x-ray phase retrieval tomography of the thorax and brain of small animals. Our method utilizes a single propagation-based x-ray phase-contrast image per projection, under the assumptions of (i) partially coherent paraxial radiation, (ii) a static object whose refractive indices take on one of a series of distinct values at each point in space and (iii) the projection approximation. For the biological samples used here, there was a 9-200 fold improvement in the signal-to-noise ratio of the phase-retrieved tomograms over the conventional attenuation-contrast signal. The ability to 'digitally dissect' a biological specimen, using only a single phase-contrast image per projection, will be useful for low-dose high-spatial-resolution biomedical imaging of form and biological function in both healthy and diseased tissue.

2D and 3D X-ray phase retrieval of multi-material objects using a single defocus distance

A method of tomographic phase retrieval is developed for multi-material objects whose components each has a distinct complex refractive index. The phase-retrieval algorithm, based on the Transport-of-Intensity equation, utilizes propagation-based X-ray phase contrast images acquired at a single defocus distance for each tomographic projection. The method requires a priori knowledge of the complex refractive index for each material present in the sample, together with the total projected thickness of the object at each orientation. The requirement of only a single defocus distance per projection simplifies the experimental setup and imposes no additional dose compared to conventional tomography. The algorithm was implemented using phase contrast data acquired at the SPring-8 Synchrotron facility in Japan. The three-dimensional (3D) complex refractive index distribution of a multi-material test object was quantitatively reconstructed using a single X-ray phase-contrast image per projection. The technique is robust in the presence of noise, compared to conventional absorption based tomography.

Analyser-based phase contrast image reconstruction using geometrical optics

Analyser-based phase contrast imaging can provide radiographs of exceptional contrast at high resolution (<100 microm), whilst quantitative phase and attenuation information can be extracted using just two images when the approximations of geometrical optics are satisfied. Analytical phase retrieval can be performed by fitting the analyser rocking curve with a symmetric Pearson type VII function. The Pearson VII function provided at least a 10% better fit to experimentally measured rocking curves than linear or Gaussian functions. A test phantom, a hollow nylon cylinder, was imaged at 20 keV using a Si(1 1 1) analyser at the ELETTRA synchrotron radiation facility. Our phase retrieval method yielded a more accurate object reconstruction than methods based on a linear fit to the rocking curve. Where reconstructions failed to map expected values, calculations of the Takagi number permitted distinction between the violation of the geometrical optics conditions and the failure of curve fitting procedures. The need for synchronized object/detector translation stages was removed by using a large, divergent beam and imaging the object in segments. Our image acquisition and reconstruction procedure enables quantitative phase retrieval for systems with a divergent source and accounts for imperfections in the analyser.

Phase contrast X-ray imaging of mice and rabbit lungs: a comparative study

The significant degree of X-ray phase contrast created by air-tissue interfaces, coupled with the poor radiographic contrast of conventional chest radiographs, makes the inflated lung an ideal candidate for investigating the potential diagnostic improvement afforded by phase contrast X-ray imaging. In small animals these methods highlight the lung airways and lobe boundaries and reveal the lung tissue as a speckled intensity pattern not seen in other soft tissues. We have compared analyser-based and propagation-based phase contrast imaging modalities, together with conventional radiographic imaging, to ascertain which technique shows the greatest image enhancement for various lung sizes. The conventional radiographic image of a mouse was obtained on a Siemens Nova 3000 mammography system, whilst phase contrast images of mice and rabbit chests were acquired at the medical imaging beamline (20B2) at the SPring-8 synchrotron radiation research facility in Japan. For mice aged 1 day, 1 week and 1 month old it was determined that analyser-based imaging showed the greatest overall image contrast, however, for an adult rabbit both techniques yielded excellent contrast. The success of these methods in creating high quality images for rabbit lungs raises the possibility of improving human lung imaging using phase contrast techniques.

Dynamic imaging of the lungs using x-ray phase contrast

High quality real-time imaging of lungs in vivo presents considerable challenges. We demonstrate here that phase contrast x-ray imaging is capable of dynamically imaging the lungs. It retains many of the advantages of simple x-ray imaging, whilst also being able to map weakly absorbing soft tissues based on refractive index differences. Preliminary results reported herein show that this novel imaging technique can identify and locate airway liquid and allows lung aeration in newborn rabbit pups to be dynamically visualized.

On the origin of speckle in x-ray phase contrast images of lung tissue

Phase contrast x-ray imaging of small animal lungs reveals a speckled intensity pattern not seen in other tissues, making the lungs highly visible in comparison to other organs. Although bearing a superficial resemblance to alveoli, the cause of this speckle has not been established. With a view to determining the mechanism for the formation of speckle, this paper details the results of propagation-based phase contrast experiments performed on mice lungs, together with packed glass microspheres used to emulate lung tissue. These experimental studies are compared to numerical simulations, based on wave propagation techniques. We find that speckle arises from focusing effects, with multiple alveoli acting as aberrated compound refractive lenses. Both experiments and modelling suggest that this speckle-formation phenomenon may lead to better screening methods for human lungs than conventional radiography.