Timothy A. Bigelow

In vivo ultrasonic attenuation slope estimates for detecting cervical ripening in rats: Preliminary results

To effectively postpone preterm birth, cervical ripening needs to be detected and delayed. As the cervix ripens, the spacing between the collagen fibers increases and fills with water, hyaluronan, decorin, and enzymes suggesting that the ultrasonic attenuation of the cervix should decrease. The decrease in ultrasonic attenuation may be detectable, leading to an effective means of detecting cervical ripening. Herein, the traditional attenuation slope-estimation algorithm based on measuring the downshift in center frequency of the ultrasonic backscattered signal with propagation depth was modified and applied to the cervix of rats. The modified algorithm was verified using computer simulations and an ex vivo tissue sample before being evaluated in in vivo animal studies. Spherically-focused f/3 transducers with 33-MHz center frequencies and with 9-mm focal lengths were used in both the simulations and experiments. The accuracy was better than 15% in the simulations, and the attenuation slope of the cervix in the ex vivo experiment was 2.6+/-0.6 dB/cm-MHz, which is comparable to 2.5+/-0.4 dB/cm-MHz measured using a through-transmission insertion loss technique. For the in vivo experiments, a statistically significant effect of ultrasonic attenuation with gestational age was not observed. The large variances in the in vivo results were most likely due to the natural variation in attenuation for biological tissue between animals.

Estimation of total attenuation and scatterer size from backscattered ultrasound waveforms

Quantitative ultrasound techniques using backscattered echoes have had limited success in vivo due to the frequency-dependent attenuation along the entire propagation path masking the frequency dependence of the backscatter. Herein, total attenuation and scatterer size are estimated simultaneously by an analysis of the in vivo backscattered power spectrum using two approaches. The simulations used to evaluate the two approaches used frequencies between 4 and 11 MHz with an effective scatterer radius of 25 microm. The first approach was based on approximations of the in vivo backscattered power spectrum (i.e., assumed Gaussian function), wherein attenuation and size were estimated by assuming each was a Gaussian transformation performed on Gaussian power spectra. The approach had poor accuracy due to the backscattered power spectra not being sufficiently modeled by a Gaussian function. The second approach estimated attenuation and size by fitting a modified reference spectrum to the in vivo backscattered power spectrum without any assumptions about the shape of the spectrum. The accuracy of the size estimate was better than 20% for signal-to-noise ratio >6 dB, window lengths greater than 4 mm, and attenuation between 0 and 1 dB/cm-MHz. However, the precision quickly degraded with increasing noise, increasing attenuation, and decreasing window length.

A theoretical comparison of attenuation measurement techniques from backscattered ultrasound echoes

Accurate characterization of tissue pathologies using ultrasonic attenuation is strongly dependent on the accuracy of the algorithm that is used to obtain the attenuation coefficient estimates. In this paper, computer simulations were used to compare the accuracy and the precision of the three methods that are commonly used to estimate the local ultrasonic attenuation within a region of interest (ROI) in tissue; namely, the spectral log difference method, the spectral difference method, and the hybrid method. The effects of the inhomgeneities within the ROI on the accuracy of the three algorithms were studied, and the optimal ROI size (the number of independent echoes laterally and the number of pulse lengths axially) was quantified for each method. The three algorithms were tested for when the ROI was homogeneous, the ROI had variations in scatterer number density, and the ROI had variations in effective scatterer size. The results showed that when the ROI was homogeneous, the spectral difference method had the highest accuracy and precision followed by the spectral log difference method and the hybrid method, respectively. Also, when the scatterer number density varied, the spectral difference method completely failed, while the log difference method and hybrid method still gave good results. Lastly, when the scatterer size varied, all of the methods failed.

Ultrasonic attenuation estimation of the pregnant cervix: A preliminary report

Estimates of ultrasonic attenuation (the loss of energy as an ultrasonic wave propagates through tissue) have been used to evaluate the structure and function of tissues in health and disease. The purpose of this research was to develop a method to estimate ultrasonic cervical attenuation during human pregnancy using a clinical ultrasound system.

Estimate of the attenuation coefficient using a clinical array transducer for the detection of cervical ripening in human pregnancy

Premature delivery is the leading cause of infant mortality in the United States. Currently, premature delivery cannot be prevented and new treatments are difficult to develop due to the inability to diagnose symptoms prior to uterine contractions. Cervical ripening is a long period that precedes the active phase of uterine contractions and cervical dilation. The changes in the microstructure of the cervix during cervical ripening suggest that the ultrasonic attenuation should decrease. The objective of this study is to use the reference phantom algorithm to estimate the ultrasonic attenuation in the cervix of pregnant human patients. Prior to applying the algorithm to in vivo human data, two homogeneous phantoms with known attenuation coefficients were used to validate the algorithm and to find the length and the width of the region of interest (ROI) that achieves the smallest error in the attenuation coefficient estimates. In the phantom data, we found that the errors in the attenuation coefficients estimates are less than 12% for ROIs that contain 40 wavelengths or more axially and 30 echo lines or more laterally. The reference phantom algorithm was then used to obtain attenuation maps of the echoes from two human pregnant cervices at different gestational ages. It was observed that the mean of the attenuation coefficient estimates in the cervix of the patient at a more advanced gestational age is smaller than the mean of the attenuation coefficient estimates in the cervix of the patient at an earlier gestational age which suggests that ultrasonic attenuation decreases with increasing gestational age. We also observed a large variance between the attenuation coefficient estimates in the different regions of the cervix due to the natural variation in tissue micro-structures across the cervix. The preliminary results indicate that the algorithm could potentially provide an important diagnostic tool for diagnosing the risk of premature delivery.

THE DESTRUCTION OF ESCHERICHIA COLI BIOFILMS USING HIGH-INTENSITY FOCUSED ULTRASOUND

High-intensity focused ultrasound (HIFU) has shown great potential for replacing surgery in many applications. In this work, HIFU was used to destroy Escherichia coli (E. coli) biofilms that had been grown on chambered microscope slides. Biofilms are central to the pathogenesis and persistence of nosocomial (hospital-acquired) infections associated with indwelling medical devices. The slides were exposed to 9.1 mus pulses at a pulse repetition frequency of 1000 Hz. The pulses were generated by a 1.1 MHz spherically focused source with a focal length of 6.3 cm and an active diameter of 7 cm. The peak rarefactional pressure for the pulses was varied as 3.1, 4.1, 5.2, 6.2 and 7.6 MPa in addition to a sham where the biofilms were not exposed. The effectiveness of the treatment was assessed by determining the number of colony forming units (CFU) remaining following exposure of the bacteria to HIFU. Most of the biofilms treated at the higher exposures of 6.2 and 7.6 MPa had no detectable CFU, indicating that bacteria in the biofilm were killed by the treatment or that treatment disrupted the biofilm and released bacteria from the slide. However, the ability of some bacteria to survive at the higher exposure settings needs to be resolved prior to implementing the treatment clinically.

Ultrasonic Attenuation and Backscatter Coefficient Estimates of Rodent-Tumor-Mimicking Structures: Comparison of Results among Clinical Scanners

In vivo estimations of the frequency-dependent acoustic attenuation (α) and backscatter (η) coefficients using radiofrequency (rf) echoes acquired with clinical ultrasound systems must be independent of the data acquisition setup and the estimation procedures. In a recent in vivo assessment of these parameters in rodent mammary tumors, overall agreement was observed among α and η estimates using data from four clinical imaging systems. In some cases, particularly in highly-attenuating heterogeneous tumors, multisystem variability was observed. This paper compares α and η estimates of a well-characterized rodent-tumor-mimicking homogeneous phantom scanned using seven transducers with the same four clinical imaging systems: a Siemens Acuson S2000, an Ultrasonix RP, a Zonare Z.one and a VisualSonics Vevo2100. α and η estimates of lesion-mimicking spheres in the phantom were independently assessed by three research groups, who analyzed their systems rf echo signals. Imaging-system-based estimates of α and η of both lesion-mimicking spheres were comparable to through-transmission laboratory estimates and to predictions using Farans theory, respectively. A few notable variations in results among the clinical systems were observed but the average and maximum percent difference between α estimates and laboratory-assessed values was 11% and 29%, respectively. Excluding a single outlier dataset, the average and maximum average difference between η estimates for the clinical systems and values predicted from scattering theory was 16% and 33%, respectively. These results were an improvement over previous interlaboratory comparisons of attenuation and backscatter estimates. Although the standardization of our estimation methodologies can be further improved, this study validates our results from previous rodent breast-tumor model studies.

Scatterer size estimation in pulse-echo ultrasound using focused sources: Theoretical approximations and simulation analysis

The speckle in ultrasound images has long been thought to contain information related to the tissue microstructure. Many different investigators have analyzed the frequency characteristics of the backscattered signals to estimate the scatterer acoustic concentration and size. Previous work has been mostly restricted to unfocused or weakly focused ultrasound sources, thus limiting its implementation with diagnostically relevant fields. Herein, we derive equations capable of estimating the size of a scatterer for any reasonably focused source provided that the velocity potential field in the focal region can be approximated as a three-dimensional Gaussian beam, scatterers are a sufficient distance from the source, and the field is approximately constant across the scatterer. The calculations show that, when estimating the scatterer size, correcting for focusing requires a generalized attenuation-compensation function that includes both attenuation and focusing along the beam axis. The Gaussian approximation is validated by comparing the ideal velocity potential field for three spherically focused sources with f-numbers of 1, 2, and 4 to the Gaussian approximation for frequencies from 2 to 14 MHz. The theoretical derivations are evaluated by simulating the backscatter by using spherically focused sources (f-numbers of 1, 2, and 4) adjacent to attenuating media (0.05 to 1 dB/cm/MHz) that contain scatterers with Gaussian impedance distributions. The generalized attenuation-compensation function yielded results accurate to 7.2% while the traditional attenuation-compensation functions that neglected focusing had errors as high as 103%.

The Thermal Index Its Strengths, Weaknesses, and Proposed Improvements

The thermal index (TI) has been used as a relative indicator of thermal risk during diagnostic ultrasound examinations for many years. It is useful in providing feedback to the clinician or sonographer, allowing assessment of relative, potential risks to the patient of an adverse effect due to a thermal mechanism. Recently, several shortcomings of the TI formulations in quantifying the risk to the patient have been identified by members of the basic scientific community, and possible improvements to address these shortcomings have been proposed. For this reason, the Output Standards Subcommittee of the American Institute of Ultrasound in Medicine convened a subcommittee to review the strengths of the TI formulations as well as their weaknesses and proposed improvements. This article summarizes the findings of this subcommittee. After a careful review of the literature and an assessment of the cost of updating the TI formulations while maximizing the quality of patient care, the Output Standards Subcommittee makes the following recommendations: (1) some inconsistencies in the current TI formulations should be resolved, and the break point distance should be redefined to take focusing into consideration; (2) an entirely new indicator of thermal risk that incorporates the time dependence not be implemented at this time but be included in continuing efforts toward standards or consensus documents; (3) the exponential dependence of risk on temperature not be incorporated into a new definition of the TI formulations at this time but be included in continuing efforts toward standards or consensus documents; (4) the TI formulations not be altered to include nonlinear propagation at this time but be included in continuing efforts toward standards or consensus documents; and (5) a new indicator for risk from thermal mechanisms should be developed, distinct from the traditional TI formulations, for new imaging modalities such as acoustic radiation force impulse imaging, which have more complicated pulsing sequences than traditional imaging.

Impact of local attenuation approximations when estimating correlation length from backscattered ultrasound echoes

Estimating the characteristic correlation length of tissue microstructure from the backscattered power spectrum could improve the diagnostic capability of medical ultrasound. Previously, size estimates were obtained after compensating for source focusing, the frequency-dependent attenuation along the propagation path (total attenuation), and the frequency-dependent attenuation in the scattering region (local attenuation). In this study, the impact of approximations of the local attenuation on the scatterer size estimate was determined using computer simulations and theoretical analysis. The simulations used Gaussian impedance distributions with an effective radius of 25 microm randomly positioned in a homogeneous half-space sonified by a spherically focused source (f/1 to f/4). The approximations of the local attenuation that were assessed neglected local attenuation (i.e., assume 0 dB/cm-MHz) neglected frequency dependence of the local attenuation, and assumed a finite frequency dependence (i.e., 0.5 dB/cm-MHz) independent of the true attenuation of the medium. Errors in the scatterer size estimate due to the local attenuation approximations increased with increasing window length, increasing true local attenuation and increasing f number. The most robust estimates were obtained when the local attenuation was approximated by a tissue-independent attenuation value that was greater than 70% of the largest attenuation expected in the tissue region of interest.