Keith A. Wear

Interlaboratory comparison of ultrasonic backscatter, attenuation, and speed measurements.

In a study involving 10 different sites, independent results of measurements of ultrasonic properties on equivalent tissue‐mimicking samples are reported and compared. The properties measured were propagation speed, attenuation coefficients, and backscatter coefficients. Reasonably good agreement exists for attenuation coefficients, but less satisfactory results were found for propagation speeds. As anticipated, agreement was not impressive in the case of backscatter coefficients. Results for four sites agreed rather well in both absolute values and frequency dependence, and results from other sites were lower by as much as an order of magnitude. The study is valuable for laboratories doing quantitative studies.

Interlaboratory Comparison of Ultrasonic Backscatter Coefficient Measurements From 2 to 9 MHz

As are the attenuation coefficient and sound speed, the backscatter coefficient is a fundamental ultrasonic property that has been used to characterize many tissues. Unfortunately, there is currently far less standardization for the ultrasonic backscatter measurement than for the other two, as evidenced by a previous American Institute of Ultrasound in Medicine (AIUM)–sponsored interlaboratory comparison of ultrasonic backscatter, attenuation, and speed measurements (J Ultrasound Med 1999; 18:615–631). To explore reasons for these disparities, the AIUM Endowment for Education and Research recently supported this second interlaboratory comparison, which extends the upper limit of the frequency range from 7 to 9 MHz.

RSNA/QIBA: Shear wave speed as a biomarker for liver fibrosis staging

An interlaboratory study of shear wave speed (SWS) estimation was performed. Commercial shear wave elastography systems from Fibroscan, Philips, Siemens and Supersonic Imagine, as well as several custom laboratory systems, were involved. Fifteen sites were included in the study. CIRS manufactured and donated 11 pairs of custom phantoms designed for the purposes of this investigation. Dynamic mechanical tests of equivalent phantom materials were also performed. The results of this study demonstrate that there is very good agreement among SWS estimation systems, but there are several sources of bias and variance that can be addressed to improve consistency of measurement results.

Decomposition of two-component ultrasound pulses in cancellous bone using modified least squares prony method--phantom experiment and simulation.

Porous media such as cancellous bone often support the simultaneous propagation of two compressional waves. When small bone samples are interrogated in through-transmission with broadband sources, these two waves often overlap in time. The modified least-squares Pronys (MLSP) method was tested for decomposing a 500 kHz-center-frequency signal containing two overlapping components: one passing through a polycarbonate plate (to produce the fast wave) and another passing through a cancellous-bone-mimicking phantom (to produce the slow wave). The MLSP method yielded estimates of attenuation slopes accurate to within 7% (polycarbonate plate) and 2% (cancellous bone phantom). The MLSP method yielded estimates of phase velocities accurate to within 1.5% (both media). The MLSP method was also tested on simulated data generated using attenuation slopes and phase velocities corresponding to bovine cancellous bone. Throughout broad ranges of signal-to-noise ratio (SNR), the MLSP method yielded estimates of attenuation slope that were accurate to within 1.0% and estimates of phase velocity that were accurate to within 4.3% (fast wave) and 1.3% (slow wave).

Conditionally Increased Acoustic Pressures in Nonfetal Diagnostic Ultrasound Examinations Without Contrast Agents: A Preliminary Assessment

The mechanical index (MI) has been used by the US Food and Drug Administration (FDA) since 1992 for regulatory decisions regarding the acoustic output of diagnostic ultrasound equipment. Its formula is based on predictions of acoustic cavitation under specific conditions. Since its implementation over 2 decades ago, new imaging modes have been developed that employ unique beam sequences exploiting higher‐order acoustic phenomena, and, concurrently, studies of the bioeffects of ultrasound under a range of imaging scenarios have been conducted. In 2012, the American Institute of Ultrasound in Medicine Technical Standards Committee convened a working group of its Output Standards Subcommittee to examine and report on the potential risks and benefits of the use of conditionally increased acoustic pressures (CIP) under specific diagnostic imaging scenarios. The term “conditionally” is included to indicate that CIP would be considered on a per‐patient basis for the duration required to obtain the necessary diagnostic information. This document is a result of that effort. In summary, a fundamental assumption in the MI calculation is the presence of a preexisting gas body. For tissues not known to contain preexisting gas bodies, based on theoretical predications and experimentally reported cavitation thresholds, we find this assumption to be invalid. We thus conclude that exceeding the recommended maximum MI level given in the FDA guidance could be warranted without concern for increased risk of cavitation in these tissues. However, there is limited literature assessing the potential clinical benefit of exceeding the MI guidelines in these tissues. The report proposes a 3‐tiered approach for CIP that follows the model for employing elevated output in magnetic resonance imaging and concludes with summary recommendations to facilitate Institutional Review Board (IRB)‐monitored clinical studies investigating CIP in specific tissues.

Statistical properties of estimates of signal-to-noise ratio and number of scatterers per resolution cell

Elementary theory underlying the relationship between the number of scatterers per resolution cell (N) and echo intensity signal-to-noise ratio (SNR) is reviewed. A relationship between the probability density functions for estimates of N and SNR2 is derived. This relationship is validated using a computer simulation. Phantom and in vitro experiments are described. In one set of experiments on phantoms, empirical distributions of estimates of N and SNR2 are measured and compared to theoretical predictions. The utility of SNR2 for discrimination of phantoms with different values for N is assessed using receiver operating characteristic (ROC) analysis. In another set of experiments, the frequency dependence of the SNR2 estimate is investigated for a two-component phantom and for excised dog kidney. It is shown that the frequency dependence of the SNR can help to identify the presence of two or more scattering components that are spatially mixed. With regard to kidney data, measurements performed both parallel and perpendicular to the predominant nephron orientation are reported. The observed anisotropy is compared to the anisotropy of backscatter coefficient encountered in previous investigations.

RSNA QIBA ultrasound shear wave speed Phase II phantom study in viscoelastic media

Using ultrasonic shear wave speed (SWS) estimates has become popular to noninvasively evaluate liver fibrosis, but significant inter-system variability in liver SWS measurements can preclude meaningful comparison of measurements performed with different systems. The RSNA Quantitative Imaging Biomarker Alliance (QIBA) ultrasound SWS committee has been developing elastic and viscoelastic (VE) phantoms to evaluate system dependencies of SWS estimates. The objective of this study is to compare SWS measurements between commercially-available systems using phantoms that have viscoelastic properties similar to those observed in normal and fibrotic liver. CIRS, Inc. fabricated three phantoms using a proprietary oil-water emulsion infused in a Zerdine® hydrogel that were matched in viscoelastic behavior to healthy and fibrotic human liver data. Phantoms were measured at academic, clinical, government and vendor sites using different systems with curvilinear arrays at multiple focal depths (3.0, 4.5 & 7.0 cm). The results of this study show that current-generation ultrasound SWS measurement systems are able to differentiate viscoelastic materials that span healthy to fibrotic liver. The deepest focal depth (7.0 cm) yielded the greatest inter-system variability for each phantom (maximum of 17.7%) as evaluated by IQR. Inter-system variability was consistent across all 3 phantoms and was not a function of stiffness. Median SWS estimates for the greatest outlier system for each phantom/focal depth combination ranged from 12.7-17.6%. Future efforts will include performing more robust statistical analyses of these data, comparing these phantom data trends with viscoelastic digital phantom data, providing vendors with study site data to refine their systems to have more consistent measurements, and integrating these data into the QIBA ultrasound shear wave speed measurement profile.

Multivariate Gaussian Pattern Classification: Effects of Finite Sample Size and the Addition of Correlated of Noisy Features on Summary Measures of Goodness

The addition of correlated or noisy features to a given feature set can degrade estimates of certain figures of merit used to characterize the class separability offered by the set. We review three such figures of merit and consider the effects of correlation and noise on their estimation from a finite training set. These effects cause some measures to be biased optimistically, others pessimistically. Previous studies of these biases have tended to overlook the large variances involved, particularly in low-dimensional space. Several methods of bias reduction are compared. A method due to Fukunaga and Hayes is compared with the “jackknife”; only the former reduces the bias without increasing the variance of the estimate for problems considered here.

Scattering by Trabecular Bone

This chapter reviews models for scattering of ultrasound by cancellous bone, methods for measuring scattering, and empirical results. Theory and measurements are presented for the dependence of backscatter on frequency and mean trabecular thickness. Additional topics discussed include the inverse problem (that is, estimating cancellous bone properties based on scattering measurements), the extent of multiple scattering in cancellous bone, and the role of scattering in determining attenuation. The potential advantages and intrinsic difficulties of backscatter as a clinical measurement are discussed. Results of clinical trials are presented.

Quantitative Estimation of Scatterer Spacing from Backscattered Ultrasound Signals Using the Complex Cepstrum

This paper presents a new method of estimating the distance between regularly-spaced coherent scatterers within soft tissue from backscattered radio-frequency (RF) signals. Periodic components in the RF signal manifest themselves as peaks in the quefrency (cepstral) domain. Using simulation data, we show that these peaks are easier to detect using the complex cepstrum rather than the commonly used power cepstrum. Similar improvements are seen using phantom and in vivo liver data.