Study of erythrocyte sedimentation in human blood through the photoacoustic signals analysis

Introduction

In this study, we utilized the pulsed photoacoustic (PA) technique to analyze globular sedimentation in whole human blood, with a focus on distinguishing between healthy individuals and those with hemolytic anemia.

Methods

Blood samples were collected from both healthy individuals (women and men) and those with hemolytic anemia, and temporal and spectral parameters of PA signals were employed for analysis.

Results

Significant differences (p < 0.05) were observed in PA metrics between the two groups. The proposed spectral analysis allowed significant differentiation within a 25-minute measurement window. Anemic blood samples exhibited higher erythrocyte sedimentation rate (ESR) values, indicating increased erythrocyte aggregation.

Discussion

This study underscores the potential of PA signal analysis in ESR assessment as an efficient method for distinguishing between healthy and anemic blood, surpassing traditional approaches. It represents a promising contribution to the development of precise and sensitive techniques for analyzing human blood samples in clinical settings.

Estimation error in speed of sound caused by rotation of measured cross-section from short-axis plane of blood vessels: a preliminary study

PURPOSE

Estimating the speed of sound (SoS) in ultrasound propagation media is important for improving the quality of B-mode images and for quantitative tissue characterization. We have been studying a method for estimating the SoS by measuring the reception time distribution of waves scattered from a scatterer at the elements in a probe. Previously, the measurement cross section was assumed to be perpendicular to the long axis of the blood vessel. In this study, we experimentally investigated the relationship between rotation angle [Formula: see text] of the probe relative to the short-axis plane of the blood vessel and the estimated SoS, [Formula: see text].

METHODS

Water tank and phantom experiments were conducted to investigate the characteristics of [Formula: see text] and element signals when the probe was rotated.

RESULTS

The received signal powers at the elements around both edges greatly decreased as [Formula: see text] increased. We introduced a parameter representing the decrease in power, [Formula: see text], in the received signal at the elements at both edges relative to the center element. [Formula: see text] was estimated to be larger as [Formula: see text] increased, especially for [Formula: see text]. [Formula: see text] also increased as [Formula: see text] increased. An approximately proportional relationship existed between the errors in [Formula: see text] and [Formula: see text].

CONCLUSION

Based on these results, we can distinguish between the presence and the absence of SoS misestimations using the difference in power among the elements in the received signal. In the absence of misestimation, we can obtain the true SoS, even if the target has a non-negligible size, by applying our previously proposed methods.

Ultrasonic Characterization of Human Scalp

OBJECTIVE

The ultrasonic properties of scalp may be relevant to a variety of applications including transcranial ultrasound. However, there is no information about the ultrasonic properties of scalp available in the literature. While ultrasonic studies of skin from other anatomic regions have been previously reported, scalp tissue is generally thicker with a higher density of hair follicles, blood vessels and sebaceous glands. Thus, it is unknown if the ultrasonic properties of scalp are similar to skin from other regions. The goal of this study was to measure the ultrasonic properties of human scalp.

METHODS

Pulse-echo measurements were performed with a 7.5 MHz ultrasound transducer to determine the speed of sound (SOS), frequency slope of attenuation (FSA) and integrated backscatter coefficient (IBC) of 32 specimens of formalin-fixed human scalp from four donors.

RESULTS

The means ± standard deviations for these three ultrasonic quantities measured in the frequency range 2.83-7.74 MHz over all specimens were SOS = 1525 ± 16.92 m/s, FSA = 2.59 ± 0.724 dB/cm/MHz and IBC = 0.122 ± 0.0746 cm-1 Sr-1.

CONCLUSION

These values are comparable to reported values for human skin from other parts of the body, but some differences in SOS and IBC exist.

Aberration correction in diagnostic ultrasound: A review of the prior field and current directions

Medical ultrasound images are reconstructed with simplifying assumptions on wave propagation, with one of the most prominent assumptions being that the imaging medium is composed of a constant sound speed. When the assumption of a constant sound speed are violated, which is true in most in vivoor clinical imaging scenarios, distortion of the transmitted and received ultrasound wavefronts appear and degrade the image quality. This distortion is known as aberration, and the techniques used to correct for the distortion are known as aberration correction techniques. Several models have been proposed to understand and correct for aberration. In this review paper, aberration and aberration correction are explored from the early models and correction techniques, including the near-field phase screen model and its associated correction techniques such as nearest-neighbor cross-correlation, to more recent models and correction techniques that incorporate spatially varying aberration and diffractive effects, such as models and techniques that rely on the estimation of the sound speed distribution in the imaging medium. In addition to historical models, future directions of ultrasound aberration correction are proposed.

An aberration correction approach for single and dual aperture ultrasound imaging of the abdomen

Abdominal ultrasound image quality is hampered by phase aberration, that is mainly caused by the large speed-of-sound (SoS) differences between fat and muscle tissue in the abdominal wall. The mismatch between the assumed and actual SoS distribution introduces general blurring of the ultrasound images, and acoustic refraction can lead to geometric distortion of the imaged features. Large aperture imaging or dual-transducer imaging can improve abdominal imaging at deep locations by providing increased contrast and resolution. However, aberration effects for large aperture imaging can be even more severe, which limits its full potential. In this study, a model-based aberration correction method for arbitrary acquisition schemes is introduced for delay-and-sum (DAS) beamforming and its performance was analyzed for both single- and dual-transducer ultrasound imaging. The method employs aberration corrected wavefront arrival times, using manually assigned local SoS values. Two wavefront models were compared. The first model is based on a straight ray approximation, and the second model on the Eikonal equation, which is solved by a multi-stencils fast marching method. Their accuracy for abdominal imaging was evaluated in acoustic simulations and phantom experiments involving tissue-mimicking and porcine material with large SoS contrast (∼100 m/s). The lateral resolution was improved by up to 90% in simulations and up to 65% in experiments compared to standard DAS, in which the use of Eikonal beamforming generally outperformed straight ray beamforming. Moreover, geometric distortions were mitigated in multi-aperture imaging, leading to a reduction in position error of around 80%. A study on the sensitivity of the aberration correction to shape and SoS of aberrating layers was performed, showing that even with imperfect segmentations or SoS values, aberration correction still outperforms standard DAS.

Acoustic evaluation of photobiomodulation effect on in vitro human blood samples

Although positive photobiomodulation response on wound healing, tissue repair, and therapeutic treatment has been widely reported, additional works are still needed to understand its effects on human blood. This research carried out acoustic measurements using A-scan (GAMPT) ultrasonic techniques to elucidate the photobiomodulation effects on in vitro human blood samples as therapeutic treatment measures. The human blood samples were irradiated using a 532-nm laser with different output laser powers (60 and 80 mW) at various exposure times. The ultrasonic velocity measured in the human blood samples after laser irradiation showed significant changes, most of which were within the acceptance limit for soft tissues (1570 [Formula: see text] 30 m/s). Abnormal cells (echinocyte and crenation) were observed due to excessive exposure during laser treatment.

Speed-of-sound estimation in ultrasound propagation medium by considering size of target scatterer

PURPOSE

Accurate speed-of-sound (SoS) estimation in an ultrasound propagation medium improves imaging quality and contributes to better diagnosis of diseases. In conventional time-delay-based SoS estimation approaches studied by several groups, a received wave is assumed to be scattered from an ideal point scatterer. In these approaches, the SoS is overestimated when the target scatterer has a non-negligible size. In this paper, we propose the SoS estimation method that considers target size.

METHODS

In the proposed method, the error ratio of the estimated SoS using the conventional time-delay-based approach is determined from measurable parameters using the geometric relationship between the received elements and target. Subsequently, the SoS erroneously estimated using conventional estimation, assuming the ideal point scatterer as a target, is corrected by the determined estimation error ratio. To validate the proposed method, the SoS in water was estimated for several wire sizes.

RESULTS

The SoS in the water was overestimated using the conventional SoS estimation method, with a maximum positive error of 38 m/s. The proposed method corrected the SoS estimates, and the errors were suppressed to within 6 m/s, irrespective of the wire diameter.

CONCLUSION

The present results demonstrate that the proposed method can estimate the SoS by considering the target size without using information on the true SoS, true target depth, and true target size, which is applicable to in vivo measurements.

Phantoms for Quantitative Ultrasound

Tissue-mimicking materials and phantoms have an important role in quantitative ultrasound. These materials allow for investigation of new techniques with the ability to design materials with properties that are stable over time and available for repeated measurements to refine techniques and analysis algorithms. This chapter presents an overview of the history of phantoms, methods of creation of materials with a variety of acoustic properties, and methods of measurement of those properties. It includes a section addressing the measurement of variance in those techniques using interlaboratory comparisons. There is a wide range of existing tissue-mimicking materials that exhibit properties similar to those of most soft tissues. Ongoing work is part of the expansion of QUS as materials are developed to better mimic specific tissues, geometries, or pathologies.

Investigation of silk as a phantom material for ultrasound and photoacoustic imaging

Comprehensive characterization of biomedical imaging systems require phantoms that are easy to fabricate and can mimic human tissue. Additionally, with the arrival of engineered tissues, it is key to develop phantoms that can mimic bioengineered samples. In ultrasound and photoacoustic imaging, water-soluble phantom materials such as gelatin undergo rapid degradation while polymer-based materials such as polyvinyl alcohol are not conducive for generating bioengineered tissues that can incorporate cells. Here we propose silk protein-based hydrogels as an ultrasound and photoacoustic phantom material that has potential to provide a 3D environment for long-term sustainable cell growth. Common acoustic, optical, and biomechanical properties such as ultrasound attenuation, reduced scattering coefficient, and Young's modulus were measured. The results indicate that silk acoustically mimics many tissue types while exhibiting similar reduced optical scattering in the wavelength range of 400-1200 nm. Furthermore, silk-based materials can be stored long-term with no change in acoustic and optical properties, and hence can be utilized to assess the performance of ultrasound and photoacoustic systems.

Assessment of the frequency dependence of acoustic properties on material, composition, and scatterer size of the medium

PURPOSE

The aim of this study was to elucidate the frequency dependence of the speed of sound (SoS) and attenuation coefficients in phantoms with controlled attenuation properties (scatterer density, scatterer size, absorption control material) and rat livers.

METHODS

The frequency dependence of SoS and attenuation coefficients were evaluated with ultrasound (1-15 MHz) by observing multiple phantoms with different scatterer sizes, densities, and presence or absence of evaporated milk as absorbing media. Normal and fatty model rat livers were examined with the same protocol.

RESULTS

The phantom results revealed that the scatterer density and SoS of the base media were the dominant factors causing the changes in SoS. Frequency dependence was not observed in SoS. Assessment of the attenuation coefficient showed that the frequency dependence was mainly affected by absorption attenuation when the scatterer was as small as a hepatocyte (i.e. ≤ 10 µm). Scattering attenuation was also observed to affect frequency dependence when the scatterer was as large as lipid droplets (i.e. ≤ 40 µm).

CONCLUSION

Assuming a consistent size of the main scatterers in the evaluation medium, the frequency dependence of the SoS and attenuation coefficients may provide insight into the scatterer density and the contribution of absorption and scattering attenuation. Further studies in the higher frequency band (up to about 50 MHz) are expected to advance the clinical application of high-frequency ultrasound.

Two-dimensional mapping of the ultrasonic attenuation and speed of sound in brain

Brain is inhomogeneous due to its composition of different tissue types (gray and white matter), anatomical structures (e.g. thalamus and cerebellum), and cavities in the brain (ventricles). These inhomogeneities lead to spatial variations in the ultrasonic properties of the organ. The goal of this study is to characterize the spatial variation of the speed of ultrasound and frequency slope of attenuation in fixed sheep brain. 1-cm-thick slices of tissue from the coronal, sagittal and transverse cardinal planes were prepared from 12 brains. Ultrasonic measurements were performed using broadband transducers with center frequencies of 3.5, 5.0, 7.5 and 10 MHz. By mechanically scanning the transducers over the specimens, two-dimensional maps of the speed of sound (SOS) and frequency slope of attenuation (FSA) were produced. Measured values for the spatial mean and standard deviation of FSA ranged between 0.59 and 0.81 dB/cm·MHz and 0.29-0.60 dB/cm·MHz, respectively, depending on the specimen and transducer frequency. Measured values for the spatial mean and standard deviation of SOS ranged from 1532-1541 m/s and 10-14 m/s, respectively. Detailed, two-dimensional maps of FSA and SOS were produced, representing the first such characterization of the spatial variation of the ultrasonic properties of normal mammalian brain.

Osteoporosis Diagnostic Model Using a Multichannel Convolutional Neural Network Based on Quantitative Ultrasound Radiofrequency Signal

Quantitative ultrasound (QUS) is a promising screening method for osteoporosis. In this study, a new method to improve the diagnostic accuracy of QUS was established in which a multichannel convolutional neural network (MCNN) processes the raw radiofrequency (RF) signal of QUS. The improvement in the diagnostic accuracy of osteoporosis using this new method was evaluated by comparison with the conventional speed of sound (SOS) method. Dual-energy X-ray absorptiometry was used as the diagnostic standard. After being trained, validated and tested in a data set consisting of 274 participants, the MCNN model could significantly raise the accuracy of osteoporosis diagnosis compared with the SOS method. The adjusted MCNN model performed even better when adjusted by age, height and weight data. The sensitivity, specificity and accuracy of the adjusted MCNN method for osteoporosis diagnosis were 80.86%, 84.23% and 83.05%, respectively; the corresponding values for SOS were 50.60%, 73.68% and 66.67%. The area under the receiver operating characteristic curve of the adjusted MCNN method was also higher than that of SOS (0.846 vs. 0.679). In conclusion, our study indicates that the MCNN method may be more accurate than the conventional SOS method. The MCNN tool and ultrasound RF signal analysis are promising future developmental directions for QUS in screening for osteoporosis.

Laser-induced sound pinging for the rapid determination of total sugar or sweetener content in commercial beverages

We recently reported on fixed-path length laser-induced sound pinging (FPL-LISP) as a rapid photoacoustic technique employing an inexpensive benchtop tattoo-removal laser for reliably determining the speed of sound in low-volume fluids. In this contribution, we demonstrate the capacity of FPL-LISP to analyze representative commercial beverages for their natural or artificial sweetener contents. As a benchmark, the speed of sound was determined for solutions of sugars (glucose, fructose, sucrose), mock high fructose corn syrup (HFCS-55), and 12 household sweeteners (culinary sugars, syrups, honey, molasses) across the concentration range of 1-20% w/v in water, simulating the typical sweetener range found in commercial soft drinks. The setup was then employed to estimate sweetener contents of 26 popular commercial beverages using the HFCS-55 standard curve as a training data set. Our results are remarkably consistent with the label values for these representative commercial beverages, in spite of the fact that some beverages clearly employ a sweetener other than HFCS-55 or a proprietary blend, suggesting the excellent potential of the FPL-LISP setup as a quick screening tool well-suited to quality control and real-time assessment in the beverage and fermentation industrial sectors. The proposed approach represents a significant improvement over many existing methods on the basis of measurement time (down to 1 s, which can be considered real time for many applications), lenient sample requirements (tens of microliters to 1 mL), robust and user-friendly analysis, practical considerations (e.g., economical, minimal service and maintenance concerns), and prospects for advancing both online monitoring and fully portable versions of this instrumentation.

A Preliminary Study of Liver Fat Quantification Using Reported Ultrasound Speed of Sound and Attenuation Parameters

The quantification of liver fat as a diagnostic assessment of steatosis remains an important priority for non-invasive imaging systems. We derive a framework in which the unknown fat volume percentage can be estimated from a pair of ultrasound measurements. The precise estimation of ultrasound speed of sound and attenuation within the liver is found to be sufficient for estimating fat volume assuming a classic model of the properties of a composite elastic material. In this model, steatosis is represented as a random dispersion of spherical fat vacuoles with acoustic properties similar to those of edible oils. Using values of speed of sound and attenuation from the literature in which normal and steatotic livers were studied near 3.5 MHz, we describe agreement of the new estimation method with independent measures of fat. This framework holds the potential for translation to clinical scanners with which the two ultrasound measurements can be made and used for improved quantitative assessment of steatosis.

Speed of Sound Measurements of Binary Mixtures of Difluoromethane (R-32) with 2,3,3,3-Tetrafluoropropene (R-1234yf) or trans-1,3,3,3-Tetrafluoropropene (R-1234ze(E)) Refrigerants

Sound speed data measured using a dual-path pulse-echo instrument are reported for binary mixtures of difluoromethane (R-32) with 2,3,3,3-tetrafluoropropene (R-1234yf) or trans-1,3,3,3-tetrafluoropropene (R-1234ze(E)). The sound speed is reported at two compositions for each binary mixture of approximately (0.33/67) and (0.67/0.33) mole fraction at temperatures between 230 K and 345 K. Data are reported from pressures slightly above the bubble point to 12 MPa for R-32/1234yf mixtures to avoid potential polymerization reactions and to 53 MPa for the R-32/1234ze(E) mixtures. The mean uncertainty of the sound speed data are less than 0.1% of the measured value where uncertainties at individual state points range from 0.04% to 0.5% of the measured value as the conditions approach the mixture critical region. The reported data are compared to available Helmholtz-energy-explicit EOS included in REFPROP and all systems studied have average absolute deviations greater than 2%. The comparisons show that further adjustments to the mixture models are needed to provide a reasonable representation of the data within its experimental uncertainty.

Speed of sound in the IEC tissue-mimicking material and its maintenance solution as a function of temperature

Tissue-Mimicking Material (TMM) is defined on IEC International Standards and applied in assessing ultrasonic diagnostic and therapeutic equipment's basic safety and essential performance. One of the TMM that fits IEC standards specification has its recipe described at IEC 60601-2-37, and it is fabricated using glycerol (11.21 %), deionized water (82.95%), benzalkonium chloride (0.47 %), silicon carbide (0.53 %), aluminum oxide 0.3 μm (0.88%), aluminum oxide 3.0 μm (0.94 %), and agar (3.08 %). Glycerol is the component responsible for adjusting the TMM's speed of sound. Moreover, it is recommended to store TMM in a closed container immersed in a mixture of water (88.1 %)/glycerol (11.9 %) to prevent it from drying out and avoiding air contact. The literature points out TMM measurements underwater can alter the speed of sound property as TMM tends to lose glycerol. Herein, the authors proposed to assess the viability of measuring the TMM speed of sound in the water/glycerol maintenance solution. First, the authors characterized the maintenance solution's speed of sound for a temperature range of 20 °C to 45 °C. Then, the group velocity of a set of TMM was measured underwater and in the maintenance solution for the same temperature range. The respective group velocity expanded uncertainty was calculated. The results indicate it is feasible to measure TMM in the maintenance solution, achieving group velocity values with no statistical difference from the ones measured underwater in the temperature range of 20 °C to 40 °C.

Quantification of Liver Fat Content with Ultrasound: A WFUMB Position Paper

New ultrasound methods that can be used to quantitatively assess liver fat content have recently been developed. These quantitative ultrasound (QUS) methods are based on the analysis of radiofrequency echoes detected by the transducer, allowing calculation of parameters for quantifying the fat in the liver. In this position paper, after a section dedicated to the importance of quantifying liver steatosis in patients with non-alcoholic fatty liver disease and another section dedicated to the assessment of liver fat with magnetic resonance, the current clinical studies performed using QUS are summarized. These new methods include spectral-based techniques and techniques based on envelope statistics. The spectral-based techniques that have been used in clinical studies are those estimating the attenuation coefficient and those estimating the backscatter coefficient. Clinical studies that have used tools based on the envelope statistics of the backscattered ultrasound are those performed by using the acoustic structure quantification or other parameters derived from it, such as the normalized local variance, and that performed by estimating the speed of sound. Experts' opinions are reported.

Feasibility of Reference Material Certification for Speed of Sound and Attenuation Coefficient Based on Standard Tissue-Mimicking Material

Speed of sound and attenuation are essential for characterizing reference materials such as biological tissue-mimicking materials (TMMs) used in ultrasonic applications. There are many publications on the manufacture of TMMs and the measurement of their properties. However, no studies in the literature have applied the metrological approach of International Organization for Standardization (ISO) Guide 35 to certify biological ultrasound TMMs as candidates for reference materials (RMs). The work described here was aimed at studying the process for manufacturing fat, muscle and aorta artery TMMs, including the study of the homogeneity, stability, trend and characterization of TMMs. The properties of interest were the speed of sound (SoS) and attenuation coefficient (AttC) at 7.5 MHz, with target expanded uncertainty of 40 m/s and 0.3 dB/cm, respectively. The short-term stability study was 2 mo at 4°C and 40°C (simulating possible transportation conditions). The long-term stability study lasted an additional 4 mo with the TMM at 22°C (simulating possible storage conditions). Homogeneity was evaluated before the stability study. Uncertainties associated with homogeneity, stability, characterization and trend were duly calculated. No trend was observed in this study, but the AttC spread widely during the stability test, substantially enlarging the final uncertainty. Therefore, this property could not be used to certify TMM candidates as RMs. However, the SoSs for most TMMs lay within the target uncertainty, disclosing viability to certify TMMs as RMs for this property. Assigned values for SoS were 1560 m/s for aorta TMM with an average expanded uncertainty for certificate validity of 12 mo (U_e;12=20 m/s), 1552 m/s for muscle TMM (U_e;12=20 m/s) and 1494 m/s for fat TMM (U_e;12=11 m/s). Thus, TMMs were proved suitable to be certified as RMs for SoS.

Ultrasound-assisted of alkali chloride separation using bulk ionic liquid membrane

An ultrasonic-assisted separation of alkali chloride (LiCl, NaCl, and KCl) salts have been carried out using of an hydrophobic ionic liquid membrane (ILM). The ionic liquid 1-butyl-3-methylimidazolium hexafluorophosphate and tributyl phosphate mixture have been used as ILM. An ultrasonic probe with different frequencies (25, 100, and 250) kHz have been applied as source of ultrasound generator with different times of sonication (2, 5, and 10) min in three phases system containing feed, ILM, and receiver in osmotic U-shaped tube. Also, 250, 500, and 1000 ppm of the feed (alkali chloride) concentration have been used to separate. The frequency of 250 kHz with higher sonication time provides optimum condition for separation of LiCl with lower feed concentration. The thermodynamic properties such as density and speed of sound and the related thermodynamic properties have been calculated to optimize ILM composition (x_IL = 0.45) for ultrasound-separation.

Urinary pentosidine level is associated with grip strength and gait speed in community-dwelling adults: a cross-sectional study

Background

Muscle and bone interactions might be associated with osteoporosis and sarcopenia. Urinary pentosidine and serum 25-hydroxyvitamin D (25(OH)D) might affect muscle and bone interactions. It is unclear whether these biomarkers are affected by age and sex or play a role in muscle and physical functions. We aimed to investigate the association between urinary pentosidine and serum 25(OH)D levels with muscle mass, muscle strength, and physical performance in community-dwelling adults.

Methods

Two-hundred and fifty-four middle-aged and elderly adults were enrolled. There was no significant difference in age between 97 men (75.0 ± 8.9 years) and 157 women (73.6 ± 8.1 years). The skeletal muscle mass index (SMI), grip strength, and gait speed were assessed. The urinary pentosidine level was measured. We evaluated the association of urinary pentosidine and serum 25(OH)D levels with age and sex (student’s t-test) and correlations between biomarker and each variable (Pearson’s correlation coefficients). Multiple regression analysis was performed with grip strength and gait speed as dependent variables and with age, height, weight, body mass index (BMI), speed of sound (SOS), SMI, glycated hemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), 25(OH)D, and pentosidine as independent variables using the stepwise method.

Results

The urinary pentosidine level was negatively correlated with grip strength, gait speed, eGFR, and insulin-like growth factor-1 (IGF-1) in men and with SOS, grip strength, and gait speed in women. The serum 25(OH)D level was positively correlated with IGF-1 in women and grip strength in men. Grip strength was associated with age, height, and pentosidine in men and height and pentosidine in women. Gait speed was associated with age, BMI, and pentosidine in men and age, height, and pentosidine in women.

Conclusion

Urinary pentosidine levels are significantly associated with grip strength and gait speed and may serve as a biomarker of muscle and bone interactions.

So you think you can DAS? A viewpoint on delay-and-sum beamforming

Delay-and-sum (DAS) is the most widespread digital beamformer in high-frame-rate ultrasound imaging. Its implementation is simple and compatible with real-time applications. In this viewpoint article, we describe the fundamentals of DAS beamforming. The underlying theory and numerical approach are detailed so that users can be aware of its functioning and limitations. In particular, we discuss the importance of the f-number and speed of sound on image quality, and propose one solution to set their values from a physical viewpoint. We suggest determining the f-number from the directivity of the transducer elements and the speed of sound from the phase dispersion of the delayed signals. Simplified Matlab codes are provided for the sake of clarity and openness. The effect of the f-number and speed of sound on the lateral resolution and contrast-to-noise ratio was investigated in vitro and in vivo. If not properly preset, these two factors had a substantial negative impact on standard metrics of image quality (namely CNR and FWHM). When beamforming with DAS in vitro or in vivo, it is recommended to optimize these parameters in order to use it wisely and prevent image degradation.

Adaptive photoacoustic computed tomography

For many optical imaging modalities, image qualities are inevitably degraded by wavefront distortions caused by varying light speed. In optical microscopy and astronomy, adaptive optics (AO) has long been applied to compensate for such unwanted aberrations. Photoacoustic computed tomography (PACT), despite relying on the ultrasonic wave for image formation, suffers from the acoustic version of the same problem. However, this problem has traditionally been regarded as an inverse problem of jointly reconstructing both the initial pressure and the sound speed distributions. In this work, we proposed a method similar to indirect wavefront sensing in AO. We argued that wavefront distortions can be extracted and corrected by a frequency domain analysis of local images. In addition to an adaptively reconstructed aberration-free image, the speed of sound map can be subsequently estimated. We demonstrated the method by in silico, phantom, and in vivo experiments.

Lifestyle and Environmental Factors Affecting Bone Mass in Japanese Female Adolescents

PURPOSE

A higher peak bone mass (PBM) in adolescence lowers the risk of osteoporosis later in life. This study examined the factors affecting bone mass in female adolescents in relation to lifestyle and environmental factors to promote bone mass development before reaching PBM.

DESIGN AND METHODS

The subjects were female students aged 15-16 years and their mothers at a public high school in Osaka, Japan. Bone mass was measured using quantitative ultrasound parameters. The body composition was measured using a multi-frequency segmental body composition analyzer. Nutrient intake, exercise habits, and maternal factors as environmental factors were examined using a questionnaire.

RESULTS

Logistic regression analyses revealed that the adolescents' lean mass was significantly related to the BUA (p < .05). The adjusted odds ratio was 1.29 (95% confidence interval [CI]: 1.07-1.54). In contrast, the adolescents' exercise habit was significantly related to the SOS (p < .05). The SOS was significantly higher in the adolescents who exercised >4 times a week than in those who exercised <2-3 times a week. The adjusted odds ratio was 2.83 (95% CI: 1.06-7.56). The adolescents' nutrient intake and maternal factors were not significant factors affecting the adolescents' bone mass.

CONCLUSIONS

The present study suggests that increasing lean mass and exercising more than four times a week were important for increasing bone mass in female adolescents.

PRACTICE IMPLICATIONS

Nurses should intervene to help female adolescents acquire healthy lifestyle skills and maintain proper body composition and exercise habits to promote bone mass development before reaching PBM.

Basic concept and clinical applications of quantitative ultrasound (QUS) technologies

In the field of clinical ultrasound, the full digitalization of diagnostic equipment in the 2000s enabled the technological development of quantitative ultrasound (QUS), followed by multiple diagnostic technologies that have been put into practical use in recent years. In QUS, tissue characteristics are quantified and parameters are calculated by analyzing the radiofrequency (RF) echo signals returning to the transducer. However, the physical properties (and pathological level structure) of the biological tissues responsible for the imaging features and QUS parameters have not been sufficiently verified as there are various conditions for observing living tissue with ultrasound and inevitable discrepancies between theoretical and actual measurements. A major issue of QUS in clinical application is that the evaluation results depend on the acquisition conditions of the RF echo signal as the source of the image information, and also vary according to the model of the diagnostic device. In this paper, typical examples of QUS techniques for evaluating attenuation, speed of sound, amplitude envelope characteristics, and backscatter coefficient in living tissues are introduced. Exemplary basic research and clinical applications related to these technologies, and initiatives currently being undertaken to establish the QUS method as a true tissue characterization technology, are also discussed.

Defining disease progression in Chinese mainland people: Association between bone mineral density and knee osteoarthritis

Objective

To evaluate change in bone mineral density (BMD) during development of knee osteoarthritis (OA) in elderly Chinese community residents. Further, to monitor disease progression by recording speed of sound (SOS), one parameter of BMD provided by quantitative ultrasound measurement.

Methods

A total of 4173 community residents of the Chinese mainland were organized to complete questionnaires and relevant measurements, including anthropometry, radiology and quantitative ultrasound (QUS). SOS measurements of the distal radius were acquired using QUS measurements. The Kellgren-Lawrence (KL) grade of knee OA was evaluated by two experienced radiographers using X-rays. Finally, a general linear models analysis was performed to determine potential relationships. Further, the area under the receiver operating characteristic curve (ROC AUC) was applied to assess the distinction model.

Results

The SOS score in the OA group was significantly lower than that in the control group (p ​< ​0.001). However, after adjustment for age and body mass index (BMI), no significant difference was observed in the male population (p ​＝ ​0.841), while a significantly lower SOS score presented in knee OA participants in the female population (p ​＝ ​0.033). A turning point in SOS scores, from increasing to decreasing trends, occurred around KL grade 2; the SOS score gradually increased with progression in participants from KL grades 0 to 2, whereas the SOS score presented a significant decrease in participants with KL grades 3 and 4. The AUC for the model to distinguish OA progression was 0.891.

Conclusion

There was a non-linear and stage-specific association between SOS score and knee OA, which presented a positive relationship in early stages, but a negative relationship in advanced stages. A decline of SOS score in knee OA patients in early stages should alert clinicians to the possibility of disease progression.

The Translational potential of this article

In the present study, the relationship between OA and BMD had established by SOS. The results suggested that close monitoring of SOS in elderly Chinese communities residents with knee OA could alert disease progression involvement by an easily accessible method, and help early referral to orthopedist consultation for further examination and treatment.

Frequency-dependent attenuation reconstruction with an acoustic reflector

Attenuation of ultrasound waves varies with tissue composition, hence its estimation offers great potential for tissue characterization and diagnosis and staging of pathology. We recently proposed a method that allows to spatially reconstruct the distribution of the overall ultrasound attenuation in tissue based on computed tomography, using reflections from a passive acoustic reflector. This requires a standard ultrasound transducer operating in pulse-echo mode and a calibration protocol using water measurements, thus it can be implemented on conventional ultrasound systems with minor adaptations. Herein, we extend this method by additionally estimating and imaging the frequency-dependent nature of local ultrasound attenuation for the first time. Spatial distributions of attenuation coefficient and exponent are reconstructed, enabling an elaborate and expressive tissue-specific characterization. With simulations, we demonstrate that our proposed method yields a low reconstruction error of 0.04 dB/cm at 1 MHz for attenuation coefficient and 0.08 for the frequency exponent. With tissue-mimicking phantoms and ex-vivo bovine muscle samples, a high reconstruction contrast as well as reproducibility are demonstrated. Attenuation exponents of a gelatin-cellulose mixture and an ex-vivo bovine muscle sample were found to be, respectively, 1.4 and 0.5 on average, consistently from different images of their heterogeneous compositions. Such frequency-dependent parametrization could enable novel imaging and diagnostic techniques, as well as facilitate attenuation compensation of other ultrasound-based imaging techniques.

Formula of compressibility and using it for air, noble gases, some hydrocarbons gases, some diatomic simple gases and some other fluids

Based on solutions of the Ornstein–Zernike equation (OZE) of Lennard–Jones potential for mean spherical approximation (MSA), we derive analytical formula for the compressibility assuming that the system is of low density, homogeneous, isotropic and composed of one component. Depending on this formula, we find the values of the bulk modulus and the compressibility of air at room temperature and the bulk modulus and the compressibility of Methane, Ethylene, Propylene and Propane at nine per ten of critical temperature of each hydrocarbon. Also, we find the speed of sound in the air at various temperatures, the speed of sound in each of Helium, Neon, Argon, Krypton, Xenon, Methane, Ethylene, Propylene, Propane, Hydrogen, Nitrogen, Fluorine, Chlorine, Oxygen, Nitrous oxide (laughing gas), Carbon dioxide, Nitric oxide, Carbon monoxide, Sulphur dioxide and dichlorodifluoromethane at room temperature. Besides, we find the speed of sound in Methane, Ethylene, Propylene and Propane at nine per ten of critical temperature of each hydrocarbons depending on the formula we find. We show that the simple formula we derive in this work is reliable and agrees with the results obtained from other studies and literatures. We believe it can be used for many systems which are in low densities and described by Lennard–Jones potential.

Bone quality in fluoride-exposed populations: A novel application of the ultrasonic method

BACKGROUND

Various studies, mostly with animals, have provided evidence of adverse impacts of fluoride (F-) on bone density, collagen and microstructure, yet its effects on overall bone quality (strength) has not been clearly or extensively characterized in human populations.

OBJECTIVE

In this observational study, we assessed variation in an integrated measures of bone quality in a population exposed to wide-ranging F- levels (0.3 to 15.5 mg/L) in drinking water, using a novel application of non-ionizing ultrasonic method.

METHOD

We collected 871 speed of sound (SOS) measurements from 341 subjects residing in 25 communities, aged 10-70 years (188 males and 153 females). All subjects received scans of the cortical radius and tibia, and adults over the age of 19 received an additional scan of the phalanx. Associations between F- in drinking water and 24-h urine samples, and SOS as a measure of bone quality, were evaluated in bivariate and multivariable regressions adjusting for age, sex, BMI, smoking, and toothpaste use.

RESULTS

We found negative associations between F- exposure and bone quality at all three bones. Adult tibial SOS showed the strongest inverse association with F- exposure, which accounted for 20% of the variance in SOS measures (r = 0.45; n = 199; p < 0.0001). In adjusted analysis, a 1 mg/L increase in F- in drinking water was related to a reduction of 15.8 m/s (95% CI: -21.3 to -10.3), whereas a 1 mg/L increase in 24-h urinary F- (range: 0.04-39.5 mg/L) was linked to a reduction of 8.4 m/s (95% CI: -12.7, -4.12) of adult tibial SOS. Among adolescents, in contrast, weaker and non-significant inverse associations between F- exposure and SOS were found, while age, gender, and BMI were more significant predictors than in adults.

CONCLUSIONS

These results are indicative of a fluoride-induced deterioration of bone quality in humans, likely reflecting a combination of factors related to SOS: net bone loss, abnormal mineralization and collagen formation, or altered microarchitecture. The portable and low-cost ultrasound technique appears potentially useful for assessment of bone quality, and should be tested in other locations and for other bone-related disorders, to assess the feasibility of its more extensive diagnostic use in hard-to-reach rural regions.

The effects of temperature and frequency dispersion on sound speed in bulk poly (vinyl alcohol) poly (N-isopropylacrylamide) hydrogels caused by the phase transition

Bulk Poly (Vinyl Alcohol) (PVA) Poly (N-isopropyl acrylamide) (PNIPAm) hydrogel, one of the thermally responsive phase transitive hydrogels, is a versatile material due to its sharp volumetric phase transition and anomalous behaviors with facile tunability by thermal stimulation. At the lower critical solution temperature (LCST) of 33 °C, the hydrogels undergo a volumetric phase transition that causes drastic, non-monotonic change in the elastic modulus, viscosity, stiffness, and speed of sound. Here, we report the temperature and frequency dependence of the speed of sound in bulk PVA-PNIPAm hydrogel as measured by means of a planar resonant cavity. The linear response theory is applied for calculation of frequency dependent speed of sound. Comparisons find standard time of flight techniques underestimate the speed of sound by up to 6%, with variation in the frequency dependent speed of sound reaching as high as 200 m/s in the ultrasonic range of 0.2-0.8 MHz. The first characterization of frequency dependent speed of sound in PVA-PNIPAm hydrogel is addressed and delineated into its phase transition behaviors as connected to temperature. The findings can lead to better characterization of mechanical properties using ultrasonic spectroscopy, and higher resolution in ultrasonic imaging applications with dispersive media.

Tibial speed of sound changes in preterm infants during the first year of life

INTRODUCTION

Metabolic bone disease of prematurity (MBD) frequently affects preterm infants. The accurate diagnosis of the MBD remains a challenging issue despite characteristic clinical, laboratory and imaging features. Recently, non-invasive quantitative ultrasound (QUS) measuring speed of sound (SOS) has been applied to assess bone status. Limited data are available on comparison of QUS among preterm infants.

OBJECTIVE

To evaluate development of tibial bone SOS values in preterm infants during the first year of life and compare the SOS values among different birth weight categories.

METHODS

QUS was used in 153 infants below 34 weeks of gestation. The study group was divided into 3 subgroups based on birth weight (BW): ≤1000 g, 1001-1500 g and >1500 g. SOS measurement was performed at 6 and 12 months of corrected age (CA).

RESULTS

Overall, we found significant increase in mean tibial SOS between 6 and 12 months of CA (3004 ± 123 vs 3253 ± 109 m/s, p = 0.001). There were significant differences in SOS among birth weight categories at 6 months of CA (p = 0.045). However, these differences were not statistically significant at 12 months of CA (p = 0.289). The infants ≤ 1000 g scored the highest SOS values at both time points.

CONCLUSIONS

Tibial SOS significantly increases during infancy in preterm newborns. Significant variation exists in SOS at 6 months, but not at 12 months of corrected age according to BW. Moreover, inverse correlation between BW and SOS indicating better bone status was revealed in extremely low birth weight infants at both 6 or at 12 months of CA.

Oil Gel-Based Phantom for Evaluating Quantitative Accuracy of Speed of Sound Measured in Ultrasound Computed Tomography

To evaluate the quantitative accuracy of the measured speed of sound in ultrasound computed tomography for breast imaging, it is necessary to use a phantom with inclusions whose speed of sound is known. Accordingly, a phantom with known-speed-of-sound inclusions (e.g., containing water and saltwater solution) under the control of temperature was developed. In addition, an oil gel was used as the phantom material for mimicking wave refraction from fatty breast tissue to dense breast tissue. The oil gel was generated by adding SEBS (styrene-ethylene/butylene-styrene, 10% w/w) to paraffin oil. The oil gel-based phantom has a cylindrical shape and contains rod-shaped inclusions that can be filled with water or saltwater solution (3.5% w/w sodium chloride in water). When temperature increases, the speed of sound in the water increases, while that in the oil gel decreases; in particular, the speed of sound in the oil gel was higher than that in the water at temperatures <20.6°C, while the speed of sound in the oil gel was lower than that in the water at temperatures >20.6°C. It has been reported that the speed of sound in dense breast tissue is higher than that in water, while that in fatty breast tissue is lower than that in water. Ultrasound is refracted owing to the difference between the speed of sound in the breast tissue and that in the background water. By controlling the temperatures of the oil gel and water, the oil gel-based phantom simulates the refraction of an ultrasound wave from fatty breast tissue to dense breast tissue. For 43 d, the variation ranges of the speed of sound and attenuation in the oil gel in the reconstructed images were 0.7 m/s and 0.03 dB/MHz/cm, respectively. The concentration of the saltwater solution in the polyacrylamide gel-based phantom decreased from 1% (w/w) to 0.48% (w/w) after 24 h, while that in the oil-gel-based phantom was constant. In addition, magnetic resonance imaging of the oil gel-based phantom revealed that NiSO₄ solution was stably contained in the phantom for 42 d. It is therefore concluded that the liquid cannot penetrate the oil gel. This oil gel-based phantom with such high temporal stability is suitable for multicenter distribution and may be used for standardization of data acquisition and image reconstruction across centers.

The Speed of Sound in Rat Liver With Steatohepatitis: Ex Vivo Analysis Using Two Types of Ultrasound Systems

We have previously reported a non-invasive method that would be clinically applicable for measurement of speed of sound (SOS) in the liver. The objective of the present study was to confirm the utility of this new method for assessing over time the SOS in liver with progressive steatohepatitis of different grades and stages. Rats were divided into two groups-a control group and a steatohepatitis group-prepared by keeping the rats on a methionine and choline-deficient diet for 43 wk. The SOS through the liver tissue was measured using the new method in comparison with a pulse-receiver as the standard. The SOS through liver with steatohepatitis temporarily decreased with the fat deposition level and then increased in parallel with the progression of inflammation and fibrosis. Monitoring the change in SOS through liver tissue in individual patients with fatty liver would have considerable potential for assisting the non-invasive detection of early-stage steatohepatitis.

Doppler shift equation and measurement errors affected by spatial variation of the speed of sound in sea water

Underwater ultrasonic devices using the Doppler effect generally presuppose that the speed of sound is uniform in a propagation medium. Actually, however, the speed of sound in the sea varies with water depth, so that the assumption of such uniform speed has the potential to cause measurement errors. The present study is then involved in theoretically improving the conventional Doppler shift equation by taking into account the fact that the speed of sound is dependent on the propagation path. The study also evaluates measurement errors caused by spatial variation in the speed of sound. Interestingly, the theory predicts that only the speeds of sound at a sound source position and the target position affect the Doppler shift, and the error of the target speed, which is the value that is ultimately measured in ultrasonic Doppler devices, is inversely proportional to the ratio of the speed of sound near the target to that near the source. In order to validate the improved Doppler equation, experiments are conducted using a water tank. The measured Doppler shift data are in agreement with the theoretical predictions within the order of a few tens of hertz.

Can low-frequency guided waves at the tibia paired with machine learning differentiate between healthy and osteopenic/osteoporotic subjects? A pilot study

PURPOSE

Axial transmission quantitative acoustics (ax-QA) has shown to be a promising tool for assessing bone health and properties in a safe, inexpensive, and portable manner. This study investigated the efficacy of low-frequency ax-QA measured at the tibia, paired with a support vector machine (SVM) approach for combining multiple acoustic indicators, to diagnose osteoporosis as defined by bone mineral density.

METHODS

This pilot study measured 41 female subjects using ax-QA (flexural mode, 3 kHz) at the tibia and using dual X-ray absorptiometry (DXA) at the lumbar spine, femoral neck, and distal radius. For each location, a threshold classifier and SVM were trained to differentiate between healthy and non-healthy subjects based on the phase velocity at different frequencies. Receiver Operating Characteristics and area under curve values (AUC) were used to assess the classifiers' performances for various thresholds and class-weights.

RESULTS

The SVM outperformed the threshold classifier for all three bone locations at low false positive rates. While differentiation between healthy and non-healthy bone states was poor for the spine (AUC: 0.56 ± 0.04), good to moderate performances were observed for the radius (AUC: 0.83 ± 0.03) and hip (AUC: 0.71 ± 0.04).

CONCLUSIONS

Low-frequency ax-QA has demonstrated potential for complementing DXA in screening for osteoporosis at the radius and hip. Through further addition of acoustic indicators ax-QA could provide a diagnostic alternative in third-world countries, and bring bone health screening and monitoring into the hands of clinicians and general health practitioners everywhere.

An easy-to-handle speed of sound test object for skills labs using additive manufacturing (RAPTUS-SOS)

A new generation of speed of sound (SOS) test object is presented that is fully constructed using additive manufacturing processes with a 3D-printer. The object contains 2 compartments with thin filaments and tubes that can be filled with fluid substances. The filaments are located at equal distances to each other; the tubes have fixed diameters. Depending on the chosen fluids (e.g. water, glycerol-water, corn oil, salt water) and room temperature, the mismatch in distance or diameter depending on the SOS error has been measured using ultrasound imaging equipment. The velocity of the fluid could be calculated deductively with high accuracy (range of total error: 0.1-3.4%). The results show that 3D-printed objects or additive manufacturing techniques can be suitable to use as teaching test objects within skills labs.

The effect of long-distance running on bone strength and bone biochemical markers

It still remains controversial whether exercise will help or adversely affect the bone formation. The aim of this study was to evaluate the effect of common long-distance running on the magnitude of change in bone properties as measured by quantitative ultrasound (QUS) and bone biochemical markers. Subjects included 68 long-distance runners and 40 controls. Long-distance runners had been training in the marathon club for at least 6 months, the average period of exercise was 2 years, and running at 48.6±24.9 km per week. Otherwise, controls were people who had not experienced any specific sports before. Bone speed of sound (SOS) was measured by QUS at the distal one third radius and the mid-shaft of the tibia. Serum osteocalcin and urine deoxypyridinolin were measured in all groups. No significant differences were found in tibial and radial SOS between the two groups. Serum osteocalcin was higher in long-distance runners than control (P<0.05) in both the 30s and 40s of the participants, but urine deoxypyridinolin showed no significant difference between the two groups. It is concluded that long-distance running at the club level increases bone formation marker, but seems to do no harmful effect on bone properties as measured by QUS.

Development of a Tissue-Mimicking Phantom of the Brain for Ultrasonic Studies

Constructing tissue-mimicking phantoms of the brain for ultrasonic studies is complicated by the low backscatter coefficient of brain tissue, causing difficulties in simultaneously matching the backscatter and attenuation properties. In this work, we report on the development of a polyvinyl alcohol-based tissue-mimicking phantom with properties approaching those of human brain tissue. Polyvinyl alcohol was selected as the base material for the phantom as its properties can be varied by freeze-thaw cycling, variations in concentration and the addition of scattering inclusions, allowing some independent control of backscatter and attenuation. The ultrasonic properties (including speed of sound, attenuation and backscatter) were optimized using these methods with talc powder as an additive. It was determined that the ultrasonic properties of the phantom produced in this study are best matched to brain tissue in the frequency range 1-3 MHz, indicating its utility for laboratory ultrasonic studies in this frequency range.

Quantitative Hepatic Fat Quantification in Non-alcoholic Fatty Liver Disease Using Ultrasound-Based Techniques: A Review of Literature and Their Diagnostic Performance

Non-alcoholic fatty liver disease is a condition that is characterized by the presence of >5% fat in the liver and affects more than one billion people worldwide. If adequate and early precautions are not taken, non-alcoholic fatty liver disease can progress to cirrhosis and death. The current reference standard for detecting hepatic steatosis is a liver biopsy. However, because of the potential morbidity associated with liver biopsies, non-invasive imaging biomarkers have been extensively investigated. Magnetic resonance imaging-based methods have proven accuracy in quantifying liver steatosis; however, these techniques are costly and have limited availability. Ultrasound-based quantitative imaging techniques are increasingly utilized because of their widespread availability, ease of use and relative cost-effectiveness. Several ultrasound-based liver fat quantification techniques have been investigated, including techniques that measure changes in the acoustic properties of the liver caused by the presence of fat. In this review, we focus on quantitative ultrasound approaches and their diagnostic performance in the realm of non-alcoholic fatty liver disease.

Lower material stiffness in rupture-repaired Achilles tendon during walking: transmission-mode ultrasound for post-surgical tendon evaluation

PURPOSE

This cross-sectional study used transmission-mode ultrasound to evaluate dynamic tendon properties during walking in surgically repaired and contralateral Achilles tendon (AT), with a median (range) post-operative period of 22 (4-58) months. It was hypothesised that the axial transmission speed of ultrasound (TSOU) during walking would be slower, indicating lower material stiffness in repaired compared with contralateral AT.

METHODS

Ten patients [median (range) age 47 (37-69) years; height 180 (170-189) cm; weight 93 (62-119) kg], who had undergone open surgical repair of the AT and were clinically recovered according to their treating clinicians, walked barefoot on a treadmill at self-selected speed (1.0 ± 0.2 m/s). Synchronous measures of TSOU, sagittal ankle motion, vertical ground reaction force (GRF), and spatiotemporal gait parameters were recorded during 20 s of steady-state walking. Paired t tests were used to evaluate potential between-limb differences in TSOU, GRF, ankle motion, and spatiotemporal gait parameters.

RESULTS

TSOU was significantly lower (≈175 m/s) in the repaired than in the contralateral AT over the entire gait cycle (P < 0.05). Sagittal ankle motion was significantly greater (≈3°) in the repaired than in the contralateral limb (P = 0.036). There were no significant differences in GRF or spatiotemporal parameters between limbs.

CONCLUSIONS

Repaired AT was characterised by a lower TSOU, reflecting a lower material stiffness in the repaired tendon than in the contralateral tendon. A lower material stiffness may underpin greater ankle joint motion of the repaired limb during walking and long-term deficits in the muscle-tendon unit reported with AT repair. Treatment and rehabilitation approaches that focus on increasing the material stiffness of the repaired AT may be clinically beneficial. Transmission-mode ultrasound would seem useful for quantifying tendon properties post AT rupture repair and may have the potential to individually guide rehabilitation programmes, thereby aiding safer return to physical activity.

LEVEL OF EVIDENCE

II.

Acoustic Properties of Small Animal Soft Tissue in the Frequency Range 12-32 MHz

Quality assurance phantoms are made of tissue-mimicking materials (TMMs) the acoustic properties of which mimic those of soft tissue. However, the acoustic properties of many soft tissue types have not been measured at ultrasonic frequencies >9 MHz. With the increasing use of high-frequency ultrasound for both clinical and pre-clinical applications, it is of increasing interest to ensure that TMMs accurately reflect the acoustic properties of soft tissue at these higher frequencies. In this study, the acoustic properties of ex vivo brain, liver and kidney samples from 50 mice were assessed in the frequency range 12-32 MHz. Measurements were performed within 6 min of euthanasia in a phosphate-buffered saline solution maintained at 37.2 ± 0.2 °C. The measured mean values for the speed of sound for all organs were found to be higher than the International Electrotechnical Commission guideline recommended value for TMMs. The attenuation coefficients measured for brain, liver and kidney samples were compared with the results of previous studies at lower frequencies. Only the measured kidney attenuation coefficient was found to be in good agreement with the International Electrotechnical Commission guideline. The information provided in this study can be used as a baseline on which to manufacture a TMM suitable for high-frequency applications.

Evaluation of bone mineralization in former preterm born children: Phalangeal quantitative ultrasound cannot replace dual-energy X-ray absorptiometry

Background

Preterm infants are at risk of impaired bone health in later life. Dual-energy X-ray absorptiometry-scan (DXA) is the gold standard to determine bone mineralization. Phalangeal quantitative ultrasound (pQUS) is an alternative technique that is inexpensive, easy to use and radiation-free. The aim of this study was to investigate whether both techniques reveal equivalent results.

Materials and methods

Sixty former preterm infants (31 boys; 29 girls) received a DXA and pQUS at age 9 to 10 years. DXA measured bone mineral content (BMC) and bone mineral density (BMD) for total body and lumbar spine (L1-4), while pQUS measured the amplitude dependent speed of sound (AD-SoS) and bone transit time (BTT) at metacarpals II-IV providing continuous values and Z-scores based on age and sex. Four statistical methods evaluated the association between both techniques: Pearson's correlation coefficients, partial correlation coefficients adjusted for gestational age, height and BMI, Bland-Altman analysis and cross tabulation.

Results

Both techniques showed a statistically significant weak correlation for continuous values as well as Z-scores (0.291–0.462, p < 0.05). Boys had significant and relatively high correlations (0.468–0.585, p < 0.05). In comparison, the correlations for girls were not significant. Correlation coefficients further decreased while calculating the partial correlations. The Bland-Altman plots showed poor agreement. Sensitivity ranged from 33% to 92% and specificity from 16% to 68%. Positive and negative predictive values ranged from 4% to 38% and 82% to 97%, respectively.

Conclusions

We found statistically significant weak correlations and poor agreement between DXA and pQUS measurements. DXA is not equivalent to pQUS and therefore not replaceable by this technique in former preterm born children at the age of 9 to 10 years.

•

DXA is the golden standard to determine bone mineralization, while Quantitative ultrasound is a radiation-free alternative.

•

Four statistical tests were used to investigate the equivalence of both methods.

•

Comparison of results of 60 preterm born children at age 9 to 10 years found poor agreement between both methods.

•

There was a discrepancy in differentiating the same children with normal or reduced bone mineralization.

•

Quantitative ultrasound cannot replace the DXA scan for determination of bone mineralization in preterm born children.

Assessment of Coded Excitation Implementation for Estimating Heat-Induced Speed of Sound Changes

Speed of sound (SoS) is an acoustic property that is highly sensitive to changes in tissues. SoS can be mapped non-invasively using ultrasonic through transmission wave tomography. This however, practically limits its clinical use to the breast. A pulse-echo-based method that has broader clinical use and that can reliably measure treatment-induced changes in SoS even under poor signal-to-noise ratio (SNR) is highly desirable. The aim of this study was to evaluate the implementation of coded excitations (CoEs) to improve pulse-echo monitoring of heat-induced changes in the SoS. In this study, a binary phase modulated Barker sequence and a linear frequency-modulated chirp were compared with a common Gaussian pulse transmission. The comparison was conducted using computer simulations, as well as transmissions in both agar-gelatin phantoms and ex vivo bovine liver. SoS changes were experimentally induced by heating the specimens with a therapeutic ultrasound system. The performance of each transmission signal was evaluated by correlating the relative echo shifts to the normalized SoS measured by through transmission. The computer simulations indicated that CoEs are beneficial at very low SNR. The Barker code performed better than both the chirp and Gaussian pulses, particularly at SNRs <10 dB (R² = 0.81 ± 0.06, 0.68 ± 0.07 and 0.55 ± 0.08, respectively, at 0 dB). At high SNRs, the CoEs performed statistically on par with the Gaussian pulse. The experimental findings indicated that both Barker and chirp codes performed better than the Gaussian pulse on ex vivo liver (R² = 0.80 ± 0.15, 0.79 ± 0.15 and 0.54 ± 0.17, respectively) and comparably on agar-gelatin phantoms. In conclusion, CoEs can be beneficial for assessing temperature-induced changes in the SoS using the pulse-echo method under poor SNR.

Feasibility of quantitative ultrasonography for the detection of metabolic bone disease in preterm infants - systematic review

Metabolic bone disease of prematurity is characterised by disordered bone mineralisation and is therefore an increased fracture risk. Preterm infants are especially at risk due to incomplete in utero bone accretion during the last trimester. Currently, diagnosing metabolic bone disease mainly relies on biochemistry and radiographs. Dual-energy x-ray absorptiometry and quantitative ultrasound (US) are used less frequently. However, biochemical measurements correlate poorly with bone mineralisation and although scoring systems exist for metabolic bone disease, radiographs are subjective and do not detect early features of osteopenia. Dual energy x-ray absorptiometry is the reference standard for determining bone density in older children and adults. However, challenges with this method include movement artefact, difficulty scanning small and sick infants and a lack of normative data for young children. Quantitative US has a relatively low cost, is radiation-free and portable, and may hence be suitable for assessing bone status in preterm infants. This review aims to provide an overview of the use of quantitative US in detecting metabolic bone disease in preterm infants.

Broadband Acoustic Measurement of an Agar-Based Tissue-Mimicking-Material: A Longitudinal Study

Commercially available ultrasound quality assurance test phantoms rely on the long-term acoustic stability of the tissue-mimicking-material (TMM). Measurement of the acoustic properties of the TMM can be technically challenging, and it is important to ensure its stability. The standard technique is to film-wrap samples of TMM and to measure the acoustic properties in a water bath. In this study, a modified technique was proposed whereby the samples of TMM are measured in a preserving fluid that is intended to maintain their characteristics. The acoustic properties were evaluated using a broadband pulse-echo substitution technique over the frequency range 4.5-50 MHz at 0, 6 and 12 months using both techniques. For both techniques, the measured mean values for the speed of sound and attenuation were very similar and within the International Electrotechnical Commission-recommended value. However, the results obtained using the proposed modified technique exhibited greater stability over the 1-y period compared with the results acquired using the standard technique.

Characterization of a new ultrasound device designed for measuring cortical porosity at the human tibia: A phantom study

Quantitative ultrasound (QUS) measurements of trabecular bone are a useful tool for the assessment of osteoporotic fracture risk. However, cortical bone properties (e.g. porosity) have an impact on bone strength as well and thus current research is focused on QUS assessment of cortical bone properties. Simulation studies of ultrasound propagation through cortical bone indicate that anisotropy, calculated from the ratio of the velocities in axial and tangential directions, is correlated with porosity. However, this relationship is affected by error sources, specifically bone surface curvature and variability of probe positioning. With the aim of in vivo estimation of cortical porosity a new ultrasound device was developed, which sequentially measures velocities in 3 different directions (axial=0° and ±37.5°) using the axial transmission method. Measurements on planar porosity phantoms (0-25%) were performed to confirm the results of the afore mentioned simulation studies. Additionally, measurements on cylindrical phantoms without pores (min. radius=34mm for strongest curvature) were performed to estimate the influence of surface curvature on velocity measurements (the tibia bone surface is fairly flat but may show surface curvature in some patients). The velocities in the axial and ±37.5° directions were used to calculate an anisotropy index. The velocities measured on the porosity phantoms showed a decrease by -6.3±0.2m/s and -10.1±0.2m/s per percent increase in porosity in axial and ±37.5° directions, respectively. Surface curvature had an effect on the velocities measured in ±37.5° directions which could be minimized by a correction algorithm resulting in an error of 5m/s. The anisotropy index could be used to estimate porosity with an accuracy error of 1.5%. These results indicate that an estimation of porosity using velocity measurements in different directions might be feasible, even in bones with curved surface. These results obtained on phantom material indicate that the approach tested may be suited for porosity measurements on human tibia bone.

Association between bone mass as assessed by quantitative ultrasound and physical function in elderly women: The Fujiwara-kyo study

Objectives

This study aimed to investigate differences in physical function by bone mass category as assessed by speed of sound, and the association between bone mass and physical function in Japanese elderly women.

Methods

Participants (≥65 years, n = 954) were divided into the osteoporosis, osteopenia, and normal groups based on speed of sound values, and physical function parameters were compared among groups. In addition, the predictive ability of physical function for low bone mass was determined by area under the curve analysis. Data were collected in 4 cities in Nara, Japan, in 2007 or 2008.

Results

All physical functions were significantly lower in the osteoporotic group than in the normal group. Lower bone mass was associated with poor muscle strength and physical function after adjusting for age, height and weight. In addition, one-leg standing time and 10-m gait time were predictive of low bone mass (osteopenia and osteoporosis levels, respectively). Elderly women with low physical function, especially those with a short one-leg standing time, should be suspected of having decreased bone mass.

Conclusions

Measurements of physical function can effectively identify elderly women with low bone mass at an early stage without the need for bone mass measurements. In particular, one-leg standing time and 10-m gait time were good predictors of low bone mass, and is easy to measure, low-cost, and can be self-measured. These findings will be helpful in the prevention and treatment of osteoporosis.

Improved adaptive reconstruction of multichannel MR images

PURPOSE

To improve adaptive reconstruction of multichannel MR images by simultaneously removing nonsmooth phase and signal-loss imaging artifacts.

METHODS

The improved adaptive reconstruction consists of three steps: (1) modified multichannel images are first derived by dividing raw multichannel images by a reference image (i.e., a normalized single-channel image); (2) the modified multichannel images are smoothed by a low-pass filter; (3) adaptive spatial matched filters determined from the smoothed multichannel images are utilized to obtain multichannel combined images. Numerical simulations, as well as MRI experiments, on phantoms and human subjects are performed to evaluate and compare the effectiveness of this improved adaptive reconstruction approach against traditional coil combination methods.

RESULTS

Both simulation and MRI experimental results demonstrated that the proposed improved adaptive reconstruction method is able to obtain combined images with reduced nonsmooth phase and signal-loss imaging artifacts.

CONCLUSIONS

A novel multichannel image reconstruction method is developed that produces high quality multichannel combined images.

Metrological Validation of a Measurement Procedure for the Characterization of a Biological Ultrasound Tissue-Mimicking Material

The speed of sound and attenuation are important properties for characterizing reference materials such as biological phantoms used in ultrasound applications. There are many publications on the manufacture of ultrasonic phantoms and the characterization of their properties. However, few studies have applied the principles of metrology, such as the expression of the uncertainty of measurement. The objective of this study is to validate a method for characterizing the speed of sound and the attenuation coefficient of tissue-mimicking material (TMM) based on the expression of the measurement of uncertainty. Six 60-mm-diameter TMMs were fabricated, three 10 mm thick and three 20 mm thick. The experimental setup comprised two ultrasonic transducers, acting as transmitter or receiver depending on the stage of the measurement protocol, both with a nominal center frequency of 5 MHz and an element diameter of 12.7 mm. A sine burst of 20 cycles and 20-V peak-to-peak amplitude at 5 MHz excited the transmitter transducer, producing a maximum pressure of 0.06 MPa. The measurement method was based on the through-transmission substitution immersion technique. The speed of sound measurement system was validated using a calibrated stainless-steel cylinder as reference material, and normalized errors were <0.8. The attenuation coefficient measurement method was validated using replicated measurements under repeatability conditions. The normalized error between the two measurement sets was <1. The proposed uncertainty models for the measurements of the speed of sound and the attenuation coefficient can help other laboratories develop their own uncertainty models. These validated measurement methods can be used to certify a TMM as a reference material for biotechnological applications.

Speed of sound in muscle for use in sonomicrometry

Converting ultrasound transit time into a measure of distance when using sonomicrometry requires that the speed of sound be known. A number of different values for the speed of sound in muscle have been assumed in studies of skeletal and cardiac muscle, and in some cases the effect of temperature has been ignored. The speed of ultrasound with frequencies greater than 1MHz in skeletal and cardiac muscle is briefly reviewed, including the effects of temperature and contractile state. A simplified equation for the speed of sound in pure water is presented for the temperature range from 0-50°C. This equation can be used when calibrating sonomicrometer transducers in water. The data available indicate that the speed of sound in both cardiac and skeletal muscle can be approximated by multiplying the speed of sound in pure water at the measurement temperature by 1.045. Differences in the speed of sound in the longitudinal and transverse directions and changes with contractile state appear to be small and in most cases can probably be safely ignored. The normal variation in muscle composition does not greatly affect the speed of ultrasound in muscle, but investigators placing sonomicrometer transducers near tendons should be conscious of the much greater speed of sound in tendon and variation with loading.

The Effect of Assisted Exercise Frequency on Bone Strength in Very Low Birth Weight Preterm Infants: A Randomized Control Trial

We aimed to assess whether a twice daily assisted exercise interventional program will have a greater effect on bone strength compared to a once daily intervention or no intervention in very low birth weight (VLBW) preterm infants. Thirty-four very VLBW preterm infants (mean BW 1217 ± 55 g and mean gestational age 28.6 ± 1.1 weeks) were randomly assigned into one of three study groups: twice daily interventions (n = 13), a once daily intervention (n = 11), and no intervention (control, n = 10). The intervention was initiated at a mean of 8 ± 2.4 days of life and continued for 4 weeks. It included passive extension and flexion range-of-motion exercise of the upper and lower extremities. Bone strength was measured at enrollment and after 2 and 4 weeks using quantitative ultrasound of tibial bone speed of sound (SOS, Sunlight Omnisense™). At enrollment, the mean bone SOS was comparable between the twice daily interventions, once daily intervention and control groups (2918 ± 78, 2943 ± 119, and 2910 ± 48 m/s, respectively). As expected, the bone SOS declined in all groups during the study period (-23.6 ± 24, -68.8 ± 28, and -115.8 ± 30 m/s, respectively, p < 0.05), with a significantly attenuated decrease in bone strength in the twice daily intervention group (p = 0.03). A twice daily intervention program of assisted range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia and future fractures in VLBW preterm infants.