Home

Search

Collections

Journals

About

Contact us

My IOPscience

Medical ultrasound: research trends that may drive sensor development

This article has been downloaded from IOPscience. Please scroll down to see the full text article. 2005 J. Phys.: Conf. Ser. 15 1 (http://iopscience.iop.org/1742-6596/15/1/001) View the table of contents for this issue, or go to the journal homepage for more

Download details: IP Address: 161.53.104.110 The article was downloaded on 09/02/2012 at 11:38

Please note that terms and conditions apply.

Institute of Physics Publishing doi:10.1088/1742-6596/15/1/001

Journal of Physics: Conference Series 15 (2005) 16 Sensors & their Applications XIII

Medical ultrasound: research trends that may drive sensor development

J C Bamber Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK Email: jeff@icr.ac.uk
Abstract. This presentation provides a personal view of some of the current trends in medical ultrasound research, with a strong emphasis on those topics where capability may be restricted by lack of availability of suitable transducers.

Ultrasound may be generated, and transmitted into the body, either solely as a means of creating a signal for imaging, or to elicit a therapeutic effect by irreversibly altering the tissue or other medium introduced into the body. Transducers may act as either the source of sound or the sensor of signals generated for imaging. Traditionally the signals employed for imaging were derived relatively simply, either from echoes of the original wave as it interacts with tissue structures that scatter ultrasound or, less commonly, with the same wave after transmission through part of the body. This situation in particular is rapidly changing, and in a manner that is driving research into the development of new transducers.

(a)

(b)

Figure 1. Demonstration of the improved quality that may be obtained by deriving images from detected harmonics of the fundamental of the projected beam, requiring wide bandwidth and high sensitivity of the receiving transducer. Images courtesy of D. Cosgrove [Hill and Bamber, 2004].

2005 IOP Publishing Ltd

Optical photograph

Utrasound profile

Ultrasound C-scan

Ultrasound RTI

Ultrasound entry echo

Figure 2. Examples of C-scans derived from a 3D echo data set of a human skin tumour (benign naevus) in vivo, in the form of a C-scan at the skin surface (labelled entry echo image), a C-scan through the centre of the lesion (labelled C-scan) and a relative attenuation, or shadow, image (known as a reflex transmission image and labelled ultrasound RTI) formed by integrating the echo magnitude from a large range of depths situated in the broad beam region beyond the focus of an F0.95 transducer. These images were made possible by first applying an echo tracking algorithm to automatically detect, and correct for, the distance of the skin surface (entry) echo from the transducer, so that the constant depth associated with a C-scan represented constant distance below the skin surface. A by-product of such tracking is the skin surface profile image that is also shown. Finally, scale and orientation registration of the ultrasound images with the optical photograph was achieved using the small triangular paper makers that are clearly visible on both ultrasound and optical images. The total image size of the ultrasound images is 22.4 x 22.4 mm. [Hill and Bamber, 2004]. Therapeutic applications of ultrasound include thermal ablation, which uses the heat absorbed locally from high intensity focused ultrasound to rapidly coagulate tissue [ter Haar and Rivens, 2005]. High power phased arrays are desirable, with good transducer cooling, especially for intracavity use. Similar requirements may be found in other applications, such as the deliberate occlusion of vessels to stop blood flow, achieved either by heat coagulation [Vaezy et al, 2001] or by the ultrasonic vaporization of perfluorocarbon liquid droplets to create temporary large intravascular bubbles [Kripfgan et al, 2004]. Other potential therapeutic applications, such enhancing the delivery of drugs or genes into cells [Mehier-Humbert et al, 2005; Newman et al, 2001], or improving the passage of substances past the blood-brain barrier [Clement, 2004; Hynynen et al, 2005], employ the phenomenon of sonoporation, whereby cell membrane (and perhaps vascular) permeability is increased by the action of ultrasound. Although these techniques do not require the power of ablative procedures, combination approaches are of increasing interest; cavitation seeding, and controlling the growth of bubbles and type of cavitation, may enhance local energy absorption in high intensity applications. Wide bandwidth as well as high power handling capability will be needed for such advanced techniques.

At the low end of the time-averaged power scale, diagnostic systems continue to drive the push towards increasing bandwidth with high sensitivity. In addition to the traditional need to maximise resolution at a given depth in tissue, techniques such as tissue harmonic imaging for improving image quality in the presence of aberrations (figure 1), and subharmonic and wideband harmonic imaging of microbubbles, for enhanced vascular imaging, also demand large bandwidth [Hill and Bamber, 2004]. The imaging of highly superficial structures such as skin tumours, and of small animals, requires extension to very high frequencies, but also very wide bandwidth [Foster et al, 2000]. Currently this is only possible with mechanically scanned single element transducers, and very high frequency arrays would be of great interest. This is particularly true of new high frequency applications of imaging methods such as the constant-depth scan (C-scan) and reflex transmission imaging, which provide high signal to noise ratio images of backscatter and attenuation, but require the rapid acquisition of three dimensional echo data if motion artefacts are to be avoided (figure 2). Four dimensional (3D plus time) imaging is gaining interest, but solutions are needed to the problems of manufacture and interfacing to high quality matrix (2D) arrays, for this field to provide its full potential in terms of quantitative flow and tissue property measurements; for example, in the field known as elastography, tissue elasticity (strain) images [Ophir et al, 2003, Bamber et al, 2002] of remarkably high signal to noise ratio may be obtained by external application of a compressive load to the tissue under controlled conditions in the laboratory (figure 3), but rapid acquisition and tracking of 3D echo data is likely to be needed for such quality to be achieved in vivo. Direct contact to curved body surfaces with minimal deformation is also desirable, for which conformal arrays [Li and ODonnell, 1995] would need to be developed.

(a)

(b)

Figure 3. Illustration of the contrast and spatial resolution achievable by processing ultrasound echoes to detect and display axial strain (change of local scale of echo structure between frames at different states of tissue compression). The images show an elastogram (axial strain image) of a canine prostate in vitro (b), and the original sonogram (a) corresponding to one of the echo data sets from which the elastogram was computed. Images courtesy of J. Ophir.

An intermediate operating region of acoustic power is emerging in which intensities higher than those previously used for imaging may be employed for short durations, to provide new or improved information. One example of this is an alternative to the method of elastography illustrated above, in

which acoustic radiation force may be used to mechanically displace tissue at depth, and an imaging beam may then be used to monitor the resulting displacement or propagating shear wave [Nightingale et al, 2003, Bercoff et al, 2004]. Another is the deliberate release of a free gas bubble from a hard-shell ultrasound contrast agent (encapsulated microbubble), which can then be transiently imaged with high contrast [Frinking et al, 2001]. Rapid switching between the actuating sound beam and the imaging beam is required in such applications, which would most conveniently be achieved with a single transducer or array that has the demanding capacity to transmit high power, receive with high sensitivity and work over a wide frequency range.

Heating to ~34oC

After ablation
Figure 4. Demonstration of temperature imaging based on a difference of sound speed generated by localised hyperthermia. Top left: a conventional B-mode image of ex-vivo bovine liver that was briefly heated using a 1.7 MHz high intensity focused ultrasound source positioned to the left of the image and with its acoustic axis horizontal in the imaging plane. Middle: images of the region of tissue indicated by the black square in the top left image, constructed by measuring the apparent axial strain (contraction) of echoes caused by heating (baseline temperature ~ 24 oC, spatial peak rise in temperature ~ 10oC). The two results illustrate the trade-off between signal to noise ratio and spatial resolution, determined by tracking and strain estimation window sizes. Noise may be seen posterior to (below) the hot spot. The noise pattern is characteristic of the shape of the heated region and is believed to be due in part to refraction of the imaging beam, the heated region acting as a thermal lens. Bottom left: another B-mode image, but created after the image above had been made and after a further rise in temperature, enough to cause irreversible tissue coagulation (~ 60oC). A bright region in this image, caused by reflections from bubbles due to cavitation in the focal region of the high intensity source, corresponds approximately in size and position with the hot spot in temperature images (centre). Right: the appearance of the tissue surface, when the specimen was cut after obtaining the image on the bottom left. Miller et al [2004)].

Similar requirements will also emerge as a result of research in which imaging methods are becoming integral to ultrasound treatment systems, for guidance and monitoring of the treatment process. Examples of this include the use of the high intensity beam to generate a small and localised temperature rise which, via the temperature dependence of sound speed, may permit a diagnostic imaging system to visualise the position and shape of the high intensity focal region [Miller et al, 2004] (see figure 4), and the use of 3D echo data to generate reflex transmission images of the ultrasonic attenuation increase associated with thermal ablation of tissues [Baker and Bamber, 2002] (see figure 5).

Transducer

Array of

FUS lesions

B-Scan

RT image

Figure 5 Reflex transmission imaging of a focused ultrasound (FUS) lesion array. In treating extended tumour volumes with focused ultrasound surgery, an array of lesions is created [ter Haar and Rivens, 2005]. This is depicted schematically top centre, and seen in cross section in the tissue cut surface top right. An ultrasound B-scan (bottom centre) shows the shadowing due to ultrasonic attenuation by the ablated tissue, and the shape of the array can be seen in the reflex transmission image (bottom right) created from a 3D echo dataset. This is a particularly exciting period in the history of medical ultrasound; the rapid development of large scale integrated circuits at low cost is fuelling ability to implement both old and new ideas for therapeutic and investigative procedures. It appears that, for a while at least, it will not be the physics of interaction of ultrasound with tissues that limits future development of the modality, but rather our imagination combined with the development of suitable transducers.

References Baker LAS, Bamber JC. Effect of dynamic receive focusing on reflex transmission imaging (RTI). pp. 1581-1584 in: Yuhas DE, Schneider SC (eds.) Proc. 2002 IEEE Ultrasonics Symposium, Vols 1 and 2, ISBN 0-7803-7582-3, IEEE, Piscataway, NJ, 2002 Bamber JC, Barbone PE, Bush NL, Cosgrove DO, Doyley MM, Fuechsel FG, Meaney PM, Miller NR, Shiina T, Tranquart F. Progress in freehand elastography of the breast. IEICE Trans on Information and Systems; 85-D(1):5-14, 2002 Bercoff J, Tanter M, Fink M. Supersonic shear imaging: A new technique for soft tissue elasticity mapping, IEEE T Ultrason Ferr; 51:396-409, 2004 Clement GT, Perspectives in clinical uses of high-intensity focused ultrasound. Ultrasonics; 42:1087-1093, 2004 Frinking PJA, Cespedes EI, Kirkhorn J, Torp HG, de Jong N. A new ultrasound contrast imaging approach based on the combination of multiple imaging pulses and a separate release burst, IEEE Transactions On Ultrasonics Ferroelectrics And Frequency Control; 48:643-651, 2001 Foster FS, Pavlin CJ, Harasiewicz KA, Christopher DA, Turnbull DH. Advances in ultrasound biomicroscopy, Ultrasound In Medicine And Biology; 26:1-27, 2000 Hill CR, Bamber JC. Methodology for Clinical Investigation. Ch.9 pp. 255-302 in: Hill CR, Bamber JC, ter Haar GR (eds.) Physical Principles of Medical Ultrasonics, 2nd Edition, John Wiley, Chichester, 2004 Hynynen K, McDannold N, Sheikov NA, Jolesz FA, Vykhodtseva N. Local and reversible blood-brain barrier disruption by noninvasive focused ultrasound at frequencies suitable for trans-skull sonications, Neuroimage; 24:12-20, 2005 Kripfgan OD, Fabiilli ML, Carson PL, FowlkesJB. On the acoustic vaporization of micrometersized droplets, J Acoust Soc Am;116:272-281, 2004 Li PC, ODonnell M. Phase aberration correction on 2-dimensional conformal arrays, IEEE Transactions On Ultrasonics Ferroelectrics And Frequency Control; 42:73-82, 1995 Mehier-Humbert S, Guy RH. Physical methods for gene transfer: Improving the kinetics of gene delivery into cells, Advanced Drug Delivery Reviews; 57:733-753, 2005 Miller NR, Bamber JC, ter Haar GR. Imaging of temperature-induced echo strain: Preliminary in vitro study to assess feasibility for guiding focused ultrasound surgery. Ultrasound Med Biol; 30:345-356, 2004 Newman CM, Lawrie A, Brisken AF, Cumberland DC. Ultrasound gene therapy: On the road from concept to reality, Echocardiogr-J Card; 18:339-347, 2001 Nightingale k, Palmeri M, Bouchard R, Trahey G. Acoustic radiation force impulse imaging: a parametric analysis of factors affecting image quality. pp. 548-553 in: 2003 IEEE Ultrasonics Symposium, IEEE, 0-7803-7922-5/03/, 2003. Ophir J, Alam SK, Garra BS, Kallel F, Konofagou E, Krouskop TA, Merritt CRB, Righetti R, Souchon R, Srinivasan S, Varghese T. Elastography: imaging the elastic properties of soft tissues with ultrasound (review article). J Med Ultrasonics; 29:155-171, 2003 ter Haar, G.R. and Rivens, I.H. (eds.). Therapeutic Ultrasound: 4th International Symposium on Therapeutic Ultrasound (AIP Conference Proceedings) ISBN: 0735402396, American Institute of Physics, Melville, NY, 2005. Vaezy S, Martin R, Crum L. Acoustic surgery, A Physics World featured article available online at http://physicsweb.org/articles/world/14/8/10, Institute of Physics, Bristol, 2001