Real-time quasi-static ultrasound elastography

Ultrasound elastography is a technique used for clinical imaging of tissue stiffness with a conventional ultrasound machine. It was first proposed two decades ago, but active research continues in this area to the present day. Numerous clinical applications have been investigated, mostly related to cancer imaging, and though these have yet to prove conclusive, the technique has seen increasing commercial and clinical interest. This paper presents a review of the most widely adopted, non-quantitative, techniques focusing on technical innovations rather than clinical applications. The review is not intended to be exhaustive, concentrating instead on placing the various techniques in context according to the authors' perspective of the field.

Stable, intelligible ultrasonic strain imaging

BACKGROUND: Freehand quasistatic strain imaging can reveal qualitative information about tissue stiffness with good spatial accuracy. Clinical trials, however, repeatedly cite instability and variable signal-to-noise ratio as significant drawbacks. METHODS: This study investigates three post-processing strategies for quasistatic strain imaging. Normalisation divides the strain by an estimate of the stress field, the intention being to reduce sensitivity to variable applied stress. Persistence aims to improve the signal-to-noise ratio by time-averaging multiple frames. The persistence scheme presented in this article operates at the pixel level, weighting each frame's contribution by an estimate of the strain precision. Precision-based display presents the clinician with an image in which regions of indeterminate strain are obscured behind a colour wash. This is achieved using estimates of strain precision that are faithfully propagated through the various stages of signal processing. RESULTS AND DISCUSSION: The post-processing strategy is evaluated qualitatively on scans of a breast biopsy phantom and in vivo head and neck examinations. Strain images processed in this manner are observed to benefit from improved stability and signal-to-noise ratio. There are, however, limitations. In unusual though conceivable circumstances, the normalisation procedure might suppress genuine stiffness variations evident in the unprocessed strain images. In different circumstances, the raw strain images might fail to capture significant stiffness variations, a situation that no amount of post-processing can improve. CONCLUSION: The clinical utility of freehand quasistatic strain imaging can be improved by normalisation, precision-weighted pixel-level persistence and precision-based display. The resulting images are stable and generally exhibit a better signal-to-noise ratio than any of the original, unprocessed strain images.

The concept of coping

Coping is action directed at the resolution or mitigation of a problematic situation. There are a number of ways in which this may be attempted, and a number of ways of classifying coping strategies. This paper presents a simple schema of six coping themes, ordered in terms of their defensiveness and the degree of attempted personal control which they imply. They comprise rejection, control, resignation, dependency, avoidance and minimization, and characterize the meaning or qualitative 'style' of the individual's response, rather than the formal characteristics of the strategies employed. Data from studies of breast cancer and surgical patients are cited to illustrate the substance of the themes.