Diagnostic Ultrasound Imaging: Inside Out (Biomedical Engineering)

801 Pages·2013·87.28 MB·English

by  Thomas L. Szabo

Diagnostic Ultrasound Imaging:
Inside Out
Second Edition
Thomas L. Szabo
Boston University, Boston, MA, USA
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Preface
Inplanningtoupdatethefirstedition,Iwasinforasurprisebecausethemedicalultrasound
landscapehadshifteddramatically.Inthelastdecade,newdevelopmentsandconcurrent
disruptivetechnologiesoverwhelmednearlyfiftyyearsofslow,steadygrowthofwhat
seemedtobeanalreadymaturetechnologyonastabletrajectory.Eventhoughthe
fundamentalscienceunderlyingmedicalultrasoundhasremainedthesame,innovationshave
expandedthecapabilitiesofdiagnosticultrasoundinthefollowingdirections;tissuecontrast
(elastography),3-Dreal-timevolumeimaging(matrixarrays),detailedbloodflow
characteristics(vectorDopplerandultrafastDopplerandColorFlow),highspeedand
throughput(planewavecompounding,Fouriertransformimagingandsyntheticaperture),
andwidespread,lowcostultrasound(pocketultrasound).Thesenewcapabilitiescomeata
timeinwhichtheimprovementsinothermedicalimagingmodalitiesarestaticoratbest,
incremental.Furthermore,diagnosticultrasoundisgaininggroundbyprovidingreal-time
interventionalsurgeryandimagefusionandtherefore,itisoffsettingitsformerlimitationsof
restrictedvolumecoverage.Pocketultrasoundiswideningrapidlythenumberofultrasound
imagingsystemusersinsmallerclinicsanditsaffordabilityisexpandingitsglobalreach.
Medical ultrasound is sowing the seeds of its own evolution. New imaging system
architectures, the wide availability of research systems and imaging system chips are
enabling explosive growth in new applications. In addition, the fastest growing new
segment of medical ultrasound is therapeutic ultrasound including high intensity focused
ultrasound, cosmetic ultrasound and neuro-ultrasound.
This edition builds on the foundation of the first edition and presents the essentials of new
state-of-the-art developments. The new material serves as a gateway to deeper exploration.
Over 250 pages of new text and hundreds of seminal references have been added, including
138 new figures.
Someofthenewtopicsaresummarizedhere.Chapter1hasamoreuptodatemedical
ultrasoundincludingthelatestdevelopmentsandanin-depthcomparisonofdiagnostic
ultrasoundtoothermedicalimagingmodalities.Chapter4examinesandassessesdifferent
viscoelasticmodels.NewtransducermaterialshavebeenaddedtoChapter5.Additional
simulationsandholeytransducersforhighintensityfocusedultrasoundapplicationshave
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xx Preface
beenaddedtoChapter6.Informationondiffractionfieldsimulationmethodsand
conformablearraysisnowincludedinChapter7.SpeckletrackingisincludedinChapter8.
Chapter9hasbeenexpandedtocoverthreedimensionalmulti-parameterizedtissue
characterization,time-reversaltechniquesandaberrationcorrectionthroughtheskull.
Chapter10isfullofnewdevelopments:ultrasoundsystemchips,moreon3Dimaging,
interventionalimagingandimagefusion,moreonharmonicimaging,micro-beamforming,
newmatrixarrays,planewavecompounding,Fouriertransformimaging,syntheticaperture
andresearchsystemarchitectures.IncludedinChapter11areplanewaveandultrafast
Doppler,transverseoscillationandvectorDopplerandfunctionalultrasound.Chapter12has
beenupdatedbysectionsonnonlinearwavesimulatorsandacousticradiationforce
calculations.Chapter13nowincludesnewtestsystemmethodology,linearandnonlinear
forwardandbackwardfieldsimulationandnewforcebalanceapproaches.Moreon
opacification,perfusion,therapeuticultrasoundcontrastagents,ultrasound-Inducedbioeffects
relatedtocontrastagents,targetedcontrastagentapplications,monodispersedmicrobubbles
andenhancedcontrastagentvisualizationcanbefoundinChapter14.Chapter15onbioeffects
hasbeenthoroughlyrethoughtandoffersanewcomprehensivesynthesisofultrasound-induced
bioeffectsaswellasnewperspectivesonathermalbioeffectscontinuumwhichspansboth
diagnosticandtherapeuticultrasound.Anewchapter16providesanintroductiontomajor
formsofelastographyincluding1Delastography,quasi-staticelastography,sonoelastography,
shearwaveelasticityimaging,acousticradiationforceimpulseimaging,vibro-acoustography
imaging,harmonicmotionimaging,supersonicshearwaveimagingandnaturalor
physiologicalimagingandpresentsthekeyphysicalprinciplesincludingviscoelasticity,strain
imaging,nonlinearity,acousticradiationforcesandmodel-basedinversion.InChapter17can
befoundacomprehensivesweepingviewofthislargeandfastgrowingfieldincludingthe
following:HIFUsimulation,histotripsy,boilingandhemostasis,cavitation-enhancedHIFU,
monitoring,transcranialultrasound,sonothrombolysis,cosmeticultrasound,lithotripsy,
ultrasound-mediateddrugdeliveryandgenetherapy,ultrasound-inducedneurostimulationand
neuromodulationandboneandwoundhealing.
Many of the things included in this edition which were thought to be impossible a decade
ago are now technological triumphs and ingenious solutions to challenging problems. As
implied in Chapter 1, medical ultrasound continues to grow rapidly by expanding its
diagnostic and therapeutic capabilities and offering new data-rich views of anatomy and
physiological functioning. New methods such as transcranial ultrasound functional
ultrasound show promise of fulfilling the potential of unlocking and healing the brain, goals
that date back to the earliest known diagnostic ultrasound images of the brain by Dussik
brothers and the early therapeutic ultrasound work of the Fry brothers.
Thomas L. Szabo
Newburyport, Massachusetts
October 2013
Acknowledgments
This revision builds on the work of thousands of people who contributed to advancing the
science of diagnostic imaging. Those of you reading this may become, if you are not
already, part of those who are expanding the circle of medical ultrasound which is rapidly
eclipsing all other imaging modalities. Many articles, books, conversations, presentations,
visits and amazing feats of ingenuity inspired the writing of this revision.
Special thanks are due to colleagues at Boston University, Paul Barbone, Gynn Holt,
Kenneth Lutchen, Ron Roy, Bela Suki, Adam LaPrad, Brian Harvey and Tyler Wellman,
Rathan Subramanian and Gustavo Mercier for introducing me to new vistas of imaging
without ultrasound. I am indebted to Peder Pedersen for his far-sighted vision of the
growing global importance and challenges of portable and now pocket ultrasound and our
years of collaboration on these topics. Thanks to Jonathan Newell, David Isaacson and Gary
J. Saulnier for initiating me into multimodal imaging design opportunities. I appreciate alert
readers and students who helped clarify and correct the presentation of the material of the
first edition. I am thankful to Jacques S. Abramowicz, Gerald Harris, Thomas Nelson, the
late Wesley Nyborg and Marvin Ziskin for plunging me deeper into the world of bioeffects.
Over the years, my associations with the working groups of Technical Committee 87 of the
International Electrotechnical Commission, in particular Working Group 6, have enriched
my knowledge of diagnostic and therapeutic ultrasound.
There is a special group of people to whom I am particularly grateful for their patience with
my questions and/or their willingness to review and recommend improvements for the
second edition: Javier de Ana Arbeloa, Jean- Francois Aubry, Paul Barbone, Jeremy
Bercoff, Ronald Daigle, Diane Dalecki, Francis Duck, Caleb Farny, Leonid Gavrilov,
Sverre Holm, Robert McGough, Timothy Hall, Sam Howard, Jørgen A. Jensen, Jian-yu Lu,
Oleg Sapozhnikov and Joshua Soneson.
Notable conversations and talks and sometimes chance meetings with the following led me
to fascinating areas of medical ultrasound: Javier de Ana Arbeloa, Jean-Francois Aubry,
Jeffrey Bamber, Peter Barthe, Stefan Catheline, Kris Dickie, Mathias Fink, Stuart Foster,
Kullervo Hynynen , Vera Khokhlov, Elisa Konofagou, Peter A. Lewin, Kathryn
Nightingale, Mickael Tanter, Gail ter Haar, Robert Muratore, Oleg Sapozhnikov, Mike
Sekins and Dr. Feng Wu. There were many others that contributed to my understanding as
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xxii Acknowledgments
well as meetings of the Acoustical Society of America, American Institute of Ultrasound in
Medicine (AIUM), the AIUM Bioeffects Committee, the IEEE Ultrasonics Symposia, and
the International Society of Therapeutic Ultrasound.
Thanks go to those who gave advance or less known materials and figures: Olivier le
Baron, Klaus Beissner, Muyinatu Bell, Mingzhu Lu, Jeffery Ketterling, Ernest Madsen,
Pierre Mare´chal, Ali Sadeghi-Naini, and T. Nelson. In addition, I appreciate those who gave
me permission to reproduce their work: J.-F. Aubry, J. Bamber, P. Barthe, P. Burns,
S. Catheline, C. Church, R. Cleveland, C. Coussios, N. de Jong, C. Desilets, M. Doyley, K.
Ferrara, D. Miller, E. Feleppa, M. Fink, F. Forsberg, Freeman, T. Gallot, General Electric
Healthcare, J. Greenleaf, T. Hasegawa, J. Hassock, G. Hesley, S. Holm, V. Humphrey,
K. Hynynen, R. L. King, E. Konofagou, H. S. Lee, E. Madsen, Mobisante, K. Nightingale,
Y. Okamura, R. McGough, G. Norton, M. Oelze, J. Ophir, K. Parker, M. Roubidoux,
A. Sarvazyan, A. Shaw, K. Shung, Siemens Healthcare, R. Skyba, R. Subramaniam,
T. Sugimoto, M. Tanter, Toshiba America Medical Systems, G. Trahey, G. Treece,
W. Walker, V. Wilkens, F. Wu, J. Wu, and Q. Zhu.
I am indebted to Amy Lex of Philips Healthcare whose patience, generosity and support of
my many requests for images and information; these superb figures have enhanced the book
greatly and led to a book cover. I am thankful to several people at Philips for their
discussions, explanations, figures and am particularly grateful for the contributions of
Daniel Cote, Loriann Davidsen, Mike Peszynski, Rick Snyder, and Karl Thiele of Philips
Healthcare.
Thanks are also due to N. Carter, F. Geraghty, and C. Owen whose careful reading,
persistence, patience, and suggestions resulted in many improvements to the quality of the
book. Readers also helped by finding errors in the first edition. Those errors that remain
despite all their best efforts are my own.
Finally, I thank my children, Sam and Vivien for their understanding of my disappearances
and for their fun and grounding engagement. More than ever, I am deeply grateful to my
wife Deborah whose patience, wisdom, sacrifice, understanding, good cheer and support
made this work possible and enjoyable.
CHAPTER 1
Introduction
Chapter Outline
1.1 Introduction 1
1.1.1 EarlyBeginnings 2
1.1.2 Sonar 3
1.2 Echo Ranging of the Body 4
1.3 Ultrasound Portrait Photographers 7
1.4 Ultrasound Cinematographers 13
1.5 Modern Ultrasound Imaging Developments 16
1.6 Enabling Technologies for UltrasoundImaging 20
1.7 Ultrasound Imaging Safety 23
1.8 Ultrasound and Other Diagnostic Imaging Modalities 23
1.8.1 ImagingModalitiesCompared 23
1.8.2 Ultrasound 26
1.8.3 PlaneX-rays 27
1.8.4 ComputedTomographyImaging 28
1.8.5 MagneticResonanceImaging 28
1.8.6 Magnetoencephalography 29
1.8.7 PositronEmissionTomography 30
1.9 ContrastAgents 30
1.9.1 ComputedTomographyAgents 30
1.9.2 MagneticResonanceImagingAgents 31
1.9.3 UltrasoundAgents 31
1.10 Comparison of Imaging Modalities 31
1.10.1 ImageFusion 32
1.10.2 Multi-waveandInteractiveImaging 33
1.11 Conclusion 34
References 35
Bibliography 37
1.1 Introduction
Ultrasound, a type of sound we cannot hear, has enabled us to see a world otherwise
invisible to us. The purpose of this chapter is to explore medical ultrasound from its
antecedents and beginnings, relate it to sonar, describe the struggles and discoveries
necessary for its development, and provide the basic principles and reasons for its success.
DiagnosticUltrasoundImaging:InsideOut. 1
©2014ElsevierInc.Allrightsreserved.
2 Chapter 1
The development of medical ultrasound was a great international effort involving thousands
of people over sixty years, and the field is still expanding rapidly, so it is not possible to
include many of the outstanding contributors in the short space that follows. Only the
fundamentals of medical ultrasound and representative snapshots of key turning points are
given here, but additional references are provided. The critical relationship between the
growth of the science of medical ultrasound and key enabling technologies is also
examined. Why these allied technologies will continue to shape the future of ultrasound is
described. Finally, the unique role of ultrasound imaging is compared to other diagnostic
imaging modalities.
1.1.1 Early Beginnings
Robert Hooke (1635(cid:1)1703), the eminent English scientist responsible for the theory of
elasticity, pocket watches, compound microscopy, and the discovery of cells and fossils,
foresaw the use of sound for diagnosis when he wrote (Tyndall, 1875):
It may be possible to discover the motions of the internal parts of bodies, whether ani-
mal,vegetable,ormineral,bythesoundtheymake;thatonemaydiscovertheworksper-
formed in the several offices and shops of a man’s body, and therby [sic] discover what
instrument or engine is out of order, what works are going on at several times, and lie
still at others, and the like. I could proceed further, but methinks I can hardly forbear to
blush when I consider how the most part of men will look upon this: but, yet again, I
have this encouragement,not tothink allthesethings utterly impossible.
Many animals in the natural world, such as bats and dolphins, use echolocation, which is the
key principle of diagnostic ultrasound imaging. The connection between echolocation and the
medical application of sound, however, was not made until the science of underwater
exploration matured. Echolocation is the use of reflections of sound to locate objects.
Humans have been fascinated with what lies below the murky depths of water for thousands
of years. The naval term to “sound” means to measure the depth of water at sea. The ancient
Greeks probed the depths of the seas with a “sounding machine,” which was a long rope
knotted at regular intervals with a lead weight on the end. American naturalist and
philosopher Henry David Thoreau measured the depth profiles of Walden Pond near Concord,
Massachusetts, with this kind of device. Recalling his boat experiences as a young man,
American author and humorist Samuel Clemens chose his pseudonym, Mark Twain, from the
second mark or knot on a sounding lead line. While sound may or may not have been
involved in a sounding machine, except for the thud of a weight hitting the sea bottom, the
words “to sound” set the stage for the later use of actual sound for the same purpose.
The sounding-machine method was in continuous use for thousands of years until it was
replaced by ultrasound echo-ranging equipment in the twentieth century. Harold Edgerton
Introduction 3
(1986), famous for his invention of stroboscopic photography, related how his friend,
Jacques-Yves Cousteau, and his crew found an ancient Greek lead sounder (250 BC) on the
floor of the Mediterranean sea by using sound waves from a side scan sonar. After his
many contributions to the field, Edgerton used sonar and stroboscopic imaging to search for
the Loch Ness monster (Rines, Wycofff, Edgerton, & Klein, 1976).
1.1.2 Sonar
The beginnings of sonar and ultrasound for medical imaging can be traced to the sinking of
the Titanic. Shortly after the Titanic tragedy, British scientist L. F. Richardson (1913) filed
patents for detecting icebergs with underwater echo ranging. In 1913, there were no practical
ways of implementing his ideas. However, the discovery of piezoelectricity (the property by
which electrical charge is created by the mechanical deformation of a crystal) by the Curie
brothers in 1880 and the invention of the triode amplifier tube by Lee de Forest in 1907 set
the stage for further advances in pulse(cid:1)echo range measurement. The Curie brothers also
showed that the reverse piezoelectric effect (voltages applied to certain crystals cause them
to deform) could be used to transform piezoelectric materials into resonating transducers. By
the end of World War I, C. Chilowsky and P. Langevin (Biquard, 1972), a student of Pierre
Curie, took advantage of the enabling technologies of piezoelectricity for transducers and
vacuum tube amplifiers to realize practical echo ranging in water. Their high-power echo-
ranging systems were used to detect submarines. During transmissions, they observed
schools of dead fish that floated to the water surface. This shows that scientists were aware
of the potential for ultrasound-induced bioeffects from the early days of ultrasound research
(O’Brien, 1998). More details can be found in Duck (2008).
The recognition that ultrasound could cause bioeffects began an intense period of
experimentation and hopefulness. After World War I, researchers began to determine the
conditions under which ultrasound was safe. They then applied ultrasound to therapy,
surgery, and cancer treatment. The field of therapeutic ultrasound began and grew
erratically until its present revival in the forms of lithotripsy (ultrasound applied to the
breaking of kidney and gallstones) and high-intensity focused ultrasound (HIFU) for
surgery. However, this branch of medical ultrasound, which is concerned mainly with
ultrasound transmission, is distinct from the development of diagnostic applications, which
is the focus of this chapter.
During World War II, pulse(cid:1)echo ranging applied to electromagnetic waves became radar
(radio detection and ranging). Important radar contributions included a sweeping of the
pulse(cid:1)echo direction in a 360-degree pattern and the circular display of target echoes on a
plan position indicator (PPI) cathode-ray-tube screen. Radar developments hastened the
evolution of single-direction underwater ultrasound ranging devices into sonar with similar
PPI-style displays.