Simon Holbek

Safety Assessment of Advanced Imaging Sequences I: Measurements

A method for rapid measurement of intensities (Ispta), mechanical index (MI), and probe surface temperature for any ultrasound scanning sequence is presented. It uses the scanners sampling capability to give an accurate measurement of the whole imaging sequence for all emissions to yield the true distributions. The method is several orders of magnitude faster than approaches using an oscilloscope, and it also facilitates validating the emitted pressure field and the scanners emission sequence software. It has been implemented using the experimental synthetic aperture real-time ultrasound system (SARUS) scanner and the Onda AIMS III intensity measurement system (Onda Corporation, Sunnyvale, CA, USA). Four different sequences have been measured: a fixed focus emission, a duplex sequence containing B-mode and flow emissions, a vector flow sequence with B-mode and flow emissions in 17 directions, and finally a SA duplex flow sequence. A BK8820e (BK Medical, Herlev, Denmark) convex array probe is used for the first three sequences and a BK8670 linear array probe for the SA sequence. The method is shown to give the same intensity values within 0.24% of the AIMS III Soniq 5.0 (Onda Corporation, Sunnyvale, CA, USA) commercial intensity measurement program. The approach can measure and store data for a full imaging sequence in 3.8-8.2 s per spatial position. Based on Ispta, MI, and probe surface temperature, the method gives the ability to determine whether a sequence is within U.S. FDA limits, or alternatively indicate how to scale it to be within limits.

3-D Vector Flow Estimation With Row–Column-Addressed Arrays

Simulation and experimental results from 3-D vector flow estimations for a 62 + 62 2-D row-column (RC) array with integrated apodization are presented. A method for implementing a 3-D transverse oscillation (TO) velocity estimator on a 3-MHz RC array is developed and validated. First, a parametric simulation study is conducted, where flow direction, ensemble length, number of pulse cycles, steering angles, transmit/receive apodization, and TO apodization profiles and spacing are varied, to find the optimal parameter configuration. The performance of the estimator is evaluated with respect to relative mean bias B̃ and mean standard deviation σ. Second, the optimal parameter configuration is implemented on the prototype RC probe connected to the experimental ultrasound scanner SARUS. Results from measurements conducted in a flow-rig system containing a constant laminar flow and a straight-vessel phantom with a pulsating flow are presented. Both an M-mode and a steered transmit sequence are applied. The 3-D vector flow is estimated in the flow rig for four representative flow directions. In the setup with 90° beam-to-flow angle, the relative mean bias across the entire velocity profile is (-4.7, -0.9, 0.4)% with a relative standard deviation of (8.7, 5.1, 0.8)% for (Vx, Vy, Vz). The estimated peak velocity is 48.5 ± 3 cm/s giving a -3% bias. The out-of-plane velocity component perpendicular to the cross section is used to estimate volumetric flow rates in the flow rig at a 90° beam-to-flow angle. The estimated mean flow rate in this setup is 91.2 ± 3.1 L/h corresponding to a bias of -11.1%. In a pulsating flow setup, flow rate measured during five cycles is 2.3 ± 0.1 mL/stroke giving a negative 9.7% bias. It is concluded that accurate 3-D vector flow estimation can be obtained using a 2-D RC-addressed array.

3-D velocity estimation for two planes in vivo

3-D velocity vectors can provide additional flow information applicable for diagnosing cardiovascular diseases e.g. by estimating the out-of-plane velocity component. A 3-D version of the Transverse Oscillation (TO) method has previously been used to obtain this information in a carotid flow phantom with constant flow. This paper presents the first in vivo measurements of the 3-D velocity vector, which were obtained over 3 cardiac cycles in the common carotid artery of a 32-year-old healthy male volunteer. Data were acquired using a Vermon 3.5 MHz 32×32 element 2-D phased array transducer and stored on the experimental scanner SARUS. The full 3-D velocity profile can be created and examined at peak-systole and end-diastole without ECG gating in two planes. Maximum out-of-plane velocities for the three peak-systoles and end-diastoles were 68.5-5.1 cm/s and 26.3-3.3 cm/s, respectively. In the longitudinal plane, average maximum peak velocity in flow direction was 65.2-14.0 cm/s at peak-systole and 33.6-4.3 cm/s at end-diastole. A commercial BK Medical ProFocus UltraView scanner using a spectral estimator gave 79.3 cm/s and 14.6 cm/s for the same volunteer. This demonstrates that real-time 3-D vector velocity imaging without ECG gating yields quantitative in vivo estimations on flow direction and magnitude.

In vivo 3-D vector velocity estimation with continuous data

In this study, a method for estimating 3-D vector velocities at very high frame rate using continuous data acquisition is presented. An emission sequence was designed to acquire real-time continuous data in one plane. The transverse oscillation (TO) method was used to estimate 3-D vector flow in a carotid flow phantom and in vivo in the common carotid artery of a healthy 27-year old female. Based on the out-of-plane velocity component during four periodic cycles, estimated flow rates in an experimental setup was 2.96 ml/s ± 0.35 ml/s compared to the expected 3.06 ml/s ± 0.09 ml/s. In the in vivo measurements, three heart cycles acquired at 2.1 kHz showed peak out-of-plane velocities of 83 cm/s, 87 cm/s and 90 cm/s in agreement with the 92 cm/s found with spectral Doppler. Mean flow rate was estimated to 257 ml/min. The results demonstrate that accurate real-time 3-D vector velocities can be obtained using the TO method, which can be used to improve operator-independece when examining blood flow in vivo, thereby increasing accuracy and consistency.

High frame rate synthetic aperture 3D vector flow imaging

3-D blood flow quantification with high spatial and temporal resolution would strongly benefit clinical research on cardiovascular pathologies. Ultrasonic velocity techniques are known for their ability to measure blood flow with high precision at high spatial and temporal resolution. However, current volumetric ultrasonic flow methods are limited to one velocity component or restricted to a reduced field of view (FOV), e.g. fixed imaging planes, in exchange for higher temporal resolutions. To solve these problems, a previously proposed accurate 2-D high frame rate vector flow imaging (VFI) technique is extended to estimate the 3-D velocity components inside a volume at high temporal resolutions (<; 1 ms). The full 3-D vector velocities are obtained from beamformed volumetric data using synthetic aperture (SA) techniques combined with a 2-D matrix array. The method is validated using Field II simulations of flow along a straight vessel phantom and with complex flow from a 3-D computational fluid dynamics (CFD) model of a carotid bifurcation. Results from the simulations show that the 3-D velocity components are estimated with a mean relative bias of -12.8%, -10% and 1.42% for the Vx, Vy and Vz respectively; each presented a mean relative standard deviation of 11.8%, 12.3% and 1.11%.

Blood flow velocity in the popliteal vein using transverse oscillation ultrasound

Chronic venous disease is a common condition leading to varicose veins, leg edema, post-thrombotic syndrome and venous ulcerations. Ultrasound (US) is the main modality for examination of venous disease. Color Doppler and occasionally spectral Doppler US (SDUS) are used for evaluation of the venous flow. Peak velocities measured by SDUS are rarely used in a clinical setting for evaluating chronic venous disease due to inadequate reproducibility mainly caused by the angle dependency of the estimate. However, estimations of blood velocities are of importance in characterizing venous disease. Transverse Oscillation US (TOUS), a non-invasive angle independent method, has been implemented on a commercial scanner. TOUSs advantage compared to SDUS is a more elaborate visualization of complex flow. The aim of this study was to evaluate, whether TOUS perform equal to SDUS for recording velocities in the veins of the lower limbs. Four volunteers were recruited for the study. A standardized flow was provoked with a cuff compression-decompression system placed around the lower leg. The average peak velocity in the popliteal vein of the four volunteers was 151.5 cm/s for SDUS and 105.9 cm/s for TOUS (p <0.001). The average of the peak velocity standard deviations (SD) were 17.0 cm/s for SDUS and 13.1 cm/s for TOUS (p <0.005). The study indicates that TOUS estimates lower peak velocity with improved SD when compared to SDUS. TOUS may be a tool for evaluation of venous disease providing quantitative measures for the evaluation of venous blood flow.

3-D vector velocity estimation with row-column addressed arrays

The concept of 2-D row-column (RC) addressed arrays for 3-D imaging have shown to be an interesting alternative to 2-D matrix array, due to the reduced channel count. However, the properties for RC arrays to estimate blood velocities have never been reported, which is of great importance for a clinical implementation of this type of array. The aim of this study is, thus, to develop a technique for estimating 3-D vector flow with a RC array using the transverse oscillation (TO) method. The properties are explored both in a simulation study and with a prototype probe for experimental use. In both setups, a 124 channel 2-D RC array with integrated apodization, pitch = 270 μm and a center frequency of 3.0 MHz was used. The performance of the estimator was tested on a simulated vessel (Ø = 12 mm) with a parabolic flow profile and a peak velocity of 1 m/s. Measurements were made in a flowrig (Ø = 12 mm) containing a laminar parabolic flow and a peak velocity of 0.54 m/s. Data was sampled and stored on the experimental ultrasound scanner SARUS. Simulations yields relative mean biases at (-1.1%, -1.5%, -1.0%) with mean standard deviations of σ̃ were (8.5%, 9.0%, 1.4%) % for (vx; vy; vz) from a 3-D velocity vector in a 15° rotated vessel with a 75° beam-to-flow angle. In the experimental setup with a 90° beam-to-flow angle, the relative mean biases were (-2.6%, -1.3%, 1.4%) with a relative standard deviation of (5.0%, 5.2%, 1.0%) for the respective transverse, lateral and axial velocity component.

3D vector flow using a row-column addressed CMUT array

This paper presents an in-house developed 2-D capacitive micromachined ultrasonic transducer (CMUT) applied for 3-D blood flow estimation. The probe breaks with conventional transducers in two ways; first, the ultrasonic pressure field is generated from thousands of small vibrating micromachined cells, and second, elements are accessed by row and/or column indices. The 62+62 2-D row-column addressed prototype CMUT probe was used for vector flow estimation by transmitting focused ultrasound into a flow-rig with a fully developed parabolic flow. The beam-to-flow angle was 90°. The received data was beamformed and processed offline. A transverse oscillation (TO) velocity estimator was used to estimate the 3-D vector flow along a line originating from the center of the transducer. The estimated velocities in the lateral and axial direction were close to zero as expected. In the transverse direction a characteristic parabolic velocity profile was estimated with a peak velocity of 0.48 m/s ± 0.02 m/s in reference to the expected 0.54 m/s. The results presented are the first 3-D vector flow estimates obtained with a row-column CMUT probe, which demonstrates that the CMUT technology is feasible for 3-D flow estimation.

Accuracy and Precision of a Plane Wave Vector Flow Imaging Method in the Healthy Carotid Artery

The objective of the study described here was to investigate the accuracy and precision of a plane wave 2-D vector flow imaging (VFI) method in laminar and complex blood flow conditions in the healthy carotid artery. The approach was to study (i) the accuracy for complex flow by comparing the velocity field from a computational fluid dynamics (CFD) simulation to VFI estimates obtained from the scan of an anthropomorphic flow phantom and from an in vivo scan; (ii) the accuracy for laminar unidirectional flow in vivo by comparing peak systolic velocities from VFI with magnetic resonance angiography (MRA); (iii) the precision of VFI estimation in vivo at several evaluation points in the vessels. The carotid artery at the bifurcation was scanned using both fast plane wave ultrasound and MRA in 10 healthy volunteers. The MRA geometry acquired from one of the volunteers was used to fabricate an anthropomorphic flow phantom, which was also scanned using the fast plane wave sequence. The same geometry was used in a CFD simulation to calculate the velocity field. Results indicated that similar flow patterns and vortices were estimated with CFD and VFI in the phantom for the carotid bifurcation. The root-mean-square difference between CFD and VFI was within 0.12 m/s for velocity estimates in the common carotid artery and the internal branch. The root-mean-square difference was 0.17 m/s in the external branch. For the 10 volunteers, the mean difference between VFI and MRA was -0.17 m/s for peak systolic velocities of laminar flow in vivo. The precision in vivo was calculated as the mean standard deviation (SD) of estimates aligned to the heart cycle and was highest in the center of the common carotid artery (SD = 3.6% for velocity magnitudes and 4.5° for angles) and lowest in the external branch and for vortices (SD = 10.2% for velocity magnitudes and 39° for angles). The results indicate that plane wave VFI measures flow precisely and that estimates are in good agreement with a CFD simulation and MRA.

A Comparison Study of Vector Velocity, Spectral Doppler and Magnetic Resonance of Blood Flow in the Common Carotid Artery

Magnetic resonance phase contrast angiography (MRA) is the gold standard for blood flow evaluation. Spectral Doppler ultrasound (SDU) is the first clinical choice, although the method is angle dependent. Vector flow imaging (VFI) is an angle-independent ultrasound method. The aim of the study was to compare VFI- and SDU-estimated peak systolic velocities (PSV) of the common carotid artery (CCA) with PSV obtained by MRA. Furthermore, intra- and inter-observer agreement was determined. MRA estimates were significantly different from SDU estimates (left CCA: p < 0.001, right CCA: p < 0.001), but not from VFI estimates (left CCA: p = 0.28, right CCA: p = 0.18). VFI measured lower PSV in both CCAs compared with SDU (p < 0.001) with improved precision (VFI: left: 24%, right: 18%; SDU: left 38%, right: 23%). Intra- and inter-observer agreement was almost perfect for VFI and SDU (inter-observer correlation coefficient: VFI 0.88, SDU 0.91; intra-observer correlation coefficient: VFI 0.96, SDU 0.97). VFI is more accurate than SDU in evaluating PSV compared with MRA.