Daniel Rickey

Computer controlled positive displacement pump for physiological flow simulation

A computer-controlled pump for use both in the study of vascular haemodynamics and in the calibration of clinical devices which measure blood flow is designed. The novel design of this pump incorporates two rack-mounted pistons, driven into opposing cylinders by a micro-stepping motor. This approach allows the production of nearly uninterrupted steady flow, as well as a variety of pulsatile wave-forms, including waveforms with reverse flow. The capabilities of this pump to produce steady flow from 0·1 to 60 mls−1, as well as sinusoidal flow and physiological flow, such as that found in the common femoral and common carotid arteries are demonstrated. Cycle-to-cycle reproducibility is very good, with an average variation of 0·1 mls−1 over thousands of cycles.

Three-dimensional colour Doppler imaging.

We have developed a system to acquire in vivo three-dimensional (3D) colour velocity images of peripheral vasculature. A clinical ultrasound system was modified by mounting the transducer on a motor-driven translation stage, allowing planar ultrasound images to be acquired along a 37 mm long stroke. A 3D velocity image is acquired by digitizing, in synchrony with the cardiac cycle, successive video images as the transducer is moved over the skin surface. 3D images require about 1 min to acquire and 10 min to reconstruct before being viewed interactively. Image acquisition at several points in the cardiac cycle permits a cine-type reconstructed image. Geometrical, temporal and velocity accuracy of the acquisition and reconstruction have been quantified and found not to degrade the image.

A geometrically accurate vascular phantom for comparative studies of x-ray, ultrasound, and magnetic resonance vascular imaging: construction and geometrical verification.

A technique for producing accurate models of vascular segments for use in experiments that assess vessel geometry and flow has been developed and evaluated. The models are compatible with x-ray, ultrasound, and magnetic resonance (MR) imaging systems. In this paper, a model of the human carotid artery bifurcation, is evaluated that has been built using this technique. The phantom consists of a thin-walled polyester-resin replica of the bifurcation through which a blood-mimicking fluid may be circulated. The phantom is surrounded by an agar tissue-mimicking material and a series of fiducial markers. The blood- and tissue-mimicking materials have x-ray, ultrasound, and MR properties similar to blood and tissue; fiducial markers provide a means of aligning images acquired by different modalities. The root-mean-square difference between the inner wall geometry of the constructed model and the desired dimensions was 0.33 mm. Static images were successfully acquired using x-ray, ultrasound, and MR imaging systems, and are free of significant artifacts. Flow images acquired with ultrasound and MR agree qualitatively with each other, and with previously published flow patterns. Volume-flow measurements obtained with ultrasound and MR were within 4.4% of the actual values.

A velocity evaluation phantom for colour and pulsed doppler instruments

We describe a phantom designed to evaluate the velocity measurements made with colour and pulsed Doppler instruments. Using a belt to translate a large volume of semi-rigid material through the entire Doppler sample volume eliminates many of the problems associated with flow and string phantoms. A servo-motor with feedback circuitry ensures accurate control of the belt velocity with an uncertainty in the mean velocity of 0.14%. The phantom provides velocities with typical variations of 0.07 cm/s. We have demonstrated the usefulness of this phantom by evaluating the linearity and accuracy of three pulsed Doppler instruments over belt velocities ranging from 0 to 80 cm/s. In addition, the measurements show the effects of the wall filter at low belt velocities. Using this phantom, we have quantified the accuracy, linearity and precision of the velocity measurements made by three colour Doppler instruments. The results also show regions where the colour instruments are aliased and where the wall filter dominates.

Quantitative investigation of in vitro flow using three-dimensional colour Doppler ultrasound

A quantitative in vitro flow study was performed by using a three-dimensional colour Doppler imaging system. This system was based on a clinical ultrasound instrument with its transducer mounted on a motor-driven translation stage. A vascular and tissue-mimicking phantom containing two wall-less vessels, one normal and another stenotic, was used to quantify the measurement accuracy of the flow velocity and the flow field. Steady state flows, having Reynolds numbers ranging between 460 and 1300, were generated by a computer-controlled positive displacement pump. Effects of the parameter settings of the ultrasound instrument on results of the estimation of flow field were also studied. Experimental results show that our three-dimensional colour Doppler systems velocity accuracy was better than 7% of the Nyquist velocity and its spatial accuracy was better than 0.5 mm. The system showed a good correlation (r = 0.999) between the estimated and the true mean flow velocity, and a good correlation (r = 0.998) between the estimated maximum and the true mean flow velocity. This study is our first step toward validating the measurement of the three-dimensional velocity and wall shear stress distributions by using three-dimensional colour Doppler ultrasound

A doppler ultrasound clutter phantom

We describe two variations of a phantom designed to evaluate the wall filters implemented on colour and spectral Doppler instruments. Both variations use an acoustic beam splitter to place the same Doppler sample volume within a motor-driven clutter belt and a flow source, which is either a second belt (dual-belt phantom) or a vascular phantom (belt/vascular phantom). We used the dual-belt phantom to evaluate the effects of the clutter belt velocity, flow belt velocity and clutter-to-flow power ratio on the reported colour Doppler shifts. The results show that the choice of wall filter, as well as the amplitudes and velocities of the clutter and flow components, affect the measured Doppler shifts. Results obtained with the belt/vascular phantom show that colour Doppler shifts due to the moving fluid depend strongly on the clutter velocity and choice of wall filter. However, only a small dependence on Doppler signal strength was observed.

Evaluation of an automated real-time spectral analysis technique

An adaptive real-time Doppler peak-frequency tracing algorithm was evaluated in vitro and compared to manual peak-frequency traces. A computer-controlled pump was used to generate physiological flow waveforms in a vasculature-mimicking phantom. Spectral waveforms were obtained on an ATL HDI along with real-time estimates of diagnostic parameters, including maximum systolic, minimum diastolic, time-averaged peak frequencies and pulsatility and resistance indices. The effect of the signal-to-noise ratio on the measured parameters was investigated. The imprecision in the measured parameters was found to depend somewhat on the waveform shape; e.g., the imprecision in PI was 4.1% for a normal renal waveform and 8.5% for a waveform having reverse diastolic flow. The peak frequency envelopes of the same waveform data were traced manually by nine operators, and the resulting diagnostic parameters were compared to ones obtained from automated peak-frequency traces of the same waveform data. The agreement between parameters measured by the automated routine and those measured manually was found to depend somewhat on the waveform shape; e.g., the bias in the PI was 1.3% for a renal waveform lacking diastolic flow, and 12% for a waveform with reverse diastolic flow. The between-observer variations in the manual measurements ranged from 0.8% up to 9.4%. The overall variations associated with the automated traces were found to be smaller than or equal to those of the manual traces.

86: Using Optical Scanner and 3D Printer Technology to Create Lead Shielding for Radiotherapy of Facial Skin Cancer with Low Energy Photons: An Exciting Innovation

Treatment of non-melanoma skin cancers of the face using ortho-voltage radiotherapy may require lead shielding to protect vulnerable organs at risk (OAR). As the human face has many complex and intricate contours, creating a lead shield can be difficult. The process can include creating a plaster mould of a patients face to create the shield. It can be difficult or impossible for a patient who is claustrophobic or medically unable to lie flat to have a shield made by this technique. Other methods have their own shortcomings. We aimed to address some of these issues using an optical scanner and 3D printer technology.

74: Innovative Approach for Generating Soft Silicone Bolus using 3D Printing for Electron Treatment of Skin Cancers in Areas with Irregular Contours

S29 _________________________________________________________________________________________________________ cardiac four-dimensional CT (4D-CT) synchronized to the electrocardiogram were obtained in treatment position, using a prospective sequential acquisition method including the extreme phases of systole and diastole. On a MimVista® image registration workstation, dose distributions were transferred to the cardiac 4D-CT. The left coronary artery, left ventricle and heart were contoured on both phases of the cardiac cycle. The maximum and minimum doses to the left coronary, left ventricle and heart were compared using a bilateral paired Student T test. Results: Preliminary data from the first eight patients enrolled are presented. Median age was 60 years (56-71) and median planned dose to the left breast was 42.56 Gy (42.56-50) in 16 fractions (16-20). For the left coronary artery, mean dose, V5 and V20 in systole versus diastole were 6.1 Gy versus 7.9 Gy (p = 0.02), 37% versus 48% (p = 0.02) and 10% versus 16% (p = 0.04), respectively. For the left ventricle, mean dose, V5 and V20 in systole versus diastole were 1.3 Gy versus 1.6 Gy (p = 0.005), 6% versus 9% (p = 0.03) and 1% versus 2% (p > 0.1), respectively. For the whole heart, mean dose, V5 and V20 in systole versus diastole were 0.9 Gy versus 1.3 Gy (p = 0.005), 21 cc versus 32 cc (p = 0.07) and 4 cc versus 5 cc (p > 0.1), respectively. Conclusions: Beyond DIBH, systolic irradiation would be associated with a further reduction in V5, V20 and mean dose to the left coronary artery, as well as a reduction in V5 and mean dose to the left ventricle and heart as a whole. The potential clinical impact of this reduction as well as the feasibility of cardiac gated irradiation are to be further investigated.

Sci‐Sat AM: Radiation Dosimetry and Practical Therapy Solutions ‐ 07: A mould room in a box – 3D scanning and printing technology in the radiotherapy clinic

Purpose: We describe the process by which our centre is currently implementing 3D printing and scanning technology for treatment accessory fabrication. This technology can increase efficiency and accuracy of accessory design, production and placement during daily use. Methods: A low-cost 3D printer and 3D optical scanner have been purchased and are being commissioned for clinical use. Commissioning includes assessing: the accuracy of the 3D scanner through comparison with high resolution CT images; the dosimetric characteristics of polylactic acid (PLA) for electron beams; the clinical utility of the technology, and; methods for quality assurance. Results: The agreement between meshes generated using the 3D scanner and CT data was within 2 millimeters for an anthropomorphic head phantom. In terms of electron beam attenuation, 1 centimetre of printed PLA was found equivalent to 1.17 cm of water. In proof-of-concept tests, several types of treatment accessories have been prototyped to date that will benefit from this technology. These include electron and photon bolus for areas with complex surface contours including the ear for electron treatments, the extremities for photon treatments and lead shielding for orthovoltage treatments. Imaging with CT and x-ray showed minimal defects, which will have no significant clinical impact. Geometric fidelity and fit to volunteers and patients was found to be excellent. Conclusions: 3D Printing and scanning can increase efficiency in the clinic for treatments requiring custom accessories. Customized boluses and shielding had excellent fit and reduced uncertainty in positioning.