Ultrasound Imaging Using the Coherence of Estimated Channel Data.

This article introduces a novel method to estimate the coherence of ultrasound channel data from beamformed radio frequency (RF) data. Estimates of ultrasound channel data are obtained by spatially filtering acquired RF data in the frequency domain. The frequency response of the spatial filters yields outputs similar to frequency domain representations of individual channel signals. This technique performs multiple normalized cross-correlations from the outputs of multiple spatial filters. The coefficients are summed together for each pixel in the coherence-based image. Simulation results using a 64 element 2.5-MHz phased array showed an improvement in contrast-to-noise ratio (CNR) of 67%-93% and a 125%-183% improvement in speckle signal-to-noise ratio (SNR) compared with standard beamformed data. Experimental CNR using a tissue-mimicking phantom showed improvement of 43%-58%, and experimentalSNR improvement was 23%-154%. Comparisons to a previously coherence method, short-lag spatial coherence, are also presented. Preliminary in vivo images of the heart and gall bladder are also shown. This method improves CNR enabling improved visualization of anechoic regions such as cyst and blood vessels.

Mitral Valve Segmentation Using Robust Nonnegative Matrix Factorization.

Analyzing and understanding the movement of the mitral valve is of vital importance in cardiology, as the treatment and prevention of several serious heart diseases depend on it. Unfortunately, large amounts of noise as well as a highly varying image quality make the automatic tracking and segmentation of the mitral valve in two-dimensional echocardiographic videos challenging. In this paper, we present a fully automatic and unsupervised method for segmentation of the mitral valve in two-dimensional echocardiographic videos, independently of the echocardiographic view. We propose a bias-free variant of the robust non-negative matrix factorization (RNMF) along with a window-based localization approach, that is able to identify the mitral valve in several challenging situations. We improve the average f1-score on our dataset of 10 echocardiographic videos by 0.18 to a f1-score of 0.56.

Gated Transmit and Fresnel-Based Receive Beamforming With a Phased Array for Low-Cost Ultrasound Imaging.

Low-cost ultrasound imaging systems are desired for many applications outside of radiology and cardiology departments. By making ultrasound systems smaller and lower cost, the use of ultrasound has spread from these mainstays to other areas of the hospital such as emergency departments and critical care. To further miniaturize and reduce the cost of ultrasound systems, we have investigated novel Fresnel-based beamforming methods to reduce front-end hardware requirements. Previous studies with linear and curvilinear arrays demonstrated comparable imaging performance using Fresnel-based beamforming versus delay-and-sum (DAS) beamforming. In this work, we extend Fresnel-based beamforming to phased arrays with beam steering. To accomplish this in transmit mode, we introduce a technique called a gated transmit beamformer where multicycle bursts are gated using multiplexers. In receive mode, a 64-element 2.5-MHz phased array is broken up into four 16-element subapertures, and each subaperture performs Fresnel beamforming before a final beamforming step is done. Timing errors are inevitable with Fresnel-based beamforming leading to higher sidelobe and clutter levels. To suppress sidelobe and clutter contributions, we also combine this with our previous technique, dual apodization with cross correlation (DAX) to improve contrast. Field II simulations are performed to evaluate spatial resolution and contrast-to-noise ratio and compared to standard DAS beamforming. Fresnel-based and gated transmit beamforming is also implemented using synthetic aperture data from tissue-mimicking phantoms. Lastly, a hardware proof-of-concept (PoC) Fresnel beamformer was designed, assembled, and evaluated with images from tissue-mimicking phantoms and initial in vivo images.

Spatial Prediction Filtering for Medical Ultrasound in Aberration and Random Noise.

While medical ultrasound imaging has become one of the most widely used imaging modalities in clinics, it often suffers from suboptimal image quality, especially in technically difficult patients with a large amount of fat content that induces severe phase aberration effects and decreases the signal-to-noise ratio. Several researchers have proposed various techniques, which can be broadly categorized as either a phase aberration correction (PAC) technique or a coherence-based imaging technique, to address the challenges in imaging technically difficult patients. Although both families of techniques have shown some success in improving the image quality in the presence of a mild level of phase aberration and/or random noise, they often fail to achieve meaningful improvements in the image quality and, in some cases, even create severe image artifacts. In this paper, we employ an adaptive filtering technique called frequency-space prediction filtering (FXPF), which we recently introduced in ultrasound imaging, to overcome the weaknesses of existing techniques and achieve image quality improvements more effectively under varying levels of phase aberration and random noise. Using simulated and experimental phantom data with varying levels of phase aberration and random noise, we evaluate and compare the performance of FXPF with the most representative technique for each category: nearest-neighbor cross correlation (NNCC)-based PAC and the generalized coherence factor (GCF). Our simulation, experimental phantom, and in vivo results demonstrate that FXPF is highly robust in varying levels of phase aberration and noise, and always outperforms both NNCC-based PAC and GCF in terms of the contrast-to-noise ratio (CNR) and the contrast when both random noise and phase aberration are present.

Improved contrast for high frame rate imaging using coherent compounding combined with spatial matched filtering.

The concept of high frame rate ultrasound imaging (typically greater than 1000 frames per second) has inspired new fields of clinical applications for ultrasound imaging such as fast cardiovascular imaging, fast Doppler imaging and real-time 3D imaging. Coherent plane-wave compounding is a promising beamforming technique to achieve high frame rate imaging. By combining echoes from plane waves with different angles, dynamic transmit focusing is efficiently accomplished at all points in the image field. Meanwhile, the image frame rate can still be kept at a high level. Spatial matched filtering (SMF) with plane-wave insonification is a novel ultrafast beamforming method. An analytical study shows that SMF is equivalent to synthetic aperture methods that can provide dynamic transmit-receive focusing throughout the field of view. Experimental results show that plane-wave SMF has better performance than dynamic-receive focusing. In this paper, we propose integrating coherent plane-wave compounding with SMF to obtain greater image contrast. By using a combination of SMF beamformed images, image contrast is improved without degrading its high frame rate capabilities. The performance of compounded SMF (CSMF) is evaluated and compared with that of synthetic aperture focusing technique (SAFT) beamforming and compounded dynamic-receive-focus (CDRF) beamforming. The image quality of different beamforming methods was quantified in terms of contrast-to-noise ratio (CNR). Our results show that the new SMF based plane-wave compounding method provides better contrast than DAS based compounding method. Also CSMF can obtain a similar contrast level to dynamic transmit-receive focusing with only 21 transmit events.

Ultrasonic Reverberation Clutter Suppression Using Multiphase Apodization With Cross Correlation.

Despite numerous recent advances in medical ultrasound imaging, reverberation clutter from near-field anatomical structures, such as the abdominal wall, ribs, and tissue layers, is one of the major sources of ultrasound image quality degradation. Reverberation clutter signals are undesirable echoes, which arise as a result of multiple reflections of acoustic waves between the boundaries of these structures, and cause fill-in to lower image contrast. In order to mitigate the undesirable reverberation clutter effects, we present, in this paper, a new beamforming technique called multiphase apodization with cross correlation (MPAX), which is an improved version of our previous technique, dual apodization with cross correlation (DAX). While DAX uses a single pair of complementary amplitude apodizations, MPAX utilizes multiple pairs of complementary sinusoidal phase apodizations to intentionally introduce grating lobes from which an improved weighting matrix can be produced to effectively suppress reverberation clutter. Our experimental sponge phantom and preliminary in vivo results from human subjects presented in this paper suggest that MPAX is a highly effective technique in suppressing reverberation clutter and has great potential for producing high contrast ultrasound images for more accurate diagnosis in clinics.

Beamforming of sound from two-dimensional arrays using spatial matched filters.

Fully-sampled two-dimensional (2D) arrays can have two-way focusing of the ultrasound beam in both lateral directions leading to high quality, real-time three-dimensional (3D) imaging. However, fully-sampled 2D arrays with very large element counts (>16,000) are difficult to manufacture due to interconnect density and large element electrical impedance. As an alternative, row-column or crossed electrode arrays have been proposed to simplify transducer fabrication and system integration. These types of arrays consist of two one-dimensional arrays oriented perpendicular to each other. Using conventional delay-and-sum beamforming, each array performs one-way focusing in perpendicular lateral directions which yield higher sidelobe and acoustic clutter levels compared to fully-sampled 2D arrays with two-way focusing. In this paper, the use of spatial matched filters to improve focusing of row-column arrays is investigated. On receive, data from each element are first spatial match filtered in the elevation direction. After summation, the data are filtered again in the azimuth direction. Beam widths comparable to one-way focusing are seen in azimuth and beam widths comparable to two-way focusing are achieved in elevation. 3D beam patterns from computer simulation results using a 7.5 MHz 128 × 128 row-column array are shown with comparison to a fully sampled 2D array.

Performance improvement of Fresnel beamforming using dual apodization with cross-correlation.

Fresnel beamforming is a beamforming method that has a delay profile with a shape similar to a physical Fresnel lens. With 4 to 8 transmit channels, 2 receive channels, and a network of single-pole/single-throw switches, Fresnel beamforming can reduce the size, cost, and complexity of a beamformer. The performance of Fresnel beamforming is highly dependent on focal errors resulting from phase wraparound and quantization of its delay profile. Previously, we demonstrated that the performance of Fresnel beamforming relative to delayand- sum (DAS) beamforming is comparable for linear arrays at f-number = 2 and 50% bandwidth. However, focal errors for Fresnel beamforming are larger because of larger path length differences between elements, as in the case of curvilinear arrays compared with linear arrays. In this paper, we present the concept and performance evaluation of Fresnel beamforming combined with a novel clutter suppression method called dual apodization with cross-correlation (DAX) for curvilinear arrays. The contrast-to-noise ratios (CNRs) of Fresnel beamforming followed by DAX are highest at f-number = 3. At f-number = 3, the experimental results show that using DAX, the CNR for Fresnel beamforming improves from 3.7 to 10.6, compared with a CNR of 5.2 for DAS beamforming. Spatial resolution is shown to be unaffected by DAX. At f-number = 3, the lateral beamwidth and axial pulse length for Fresnel beamforming with DAX are 1.44 and 1.00 mm larger than those for DAS beamforming (about 14% and 21% larger), respectively. These experimental results are in good agreement with simulation results.

Effects of dual apodization with cross-correlation on tissue harmonic and pulse inversion harmonic imaging in the presence of phase aberration.

Dual apodization with cross-correlation (DAX) is a relatively new beamforming technique which can suppress side lobes and clutter to enhance ultrasound image contrast. However, previous studies have shown that with increasing aberrator strength, contrast enhancements with DAX diminish and DAX becomes more prone to image artifacts. In this paper, we propose integrating DAX with tissue harmonic imaging (THI) or pulse inversion harmonic imaging (PIHI) to overcome their shortcomings and achieve higher image contrast. Compared with conventional imaging, our experimental results showed that DAX with THI allows for synergistic enhancements of image contrast with improvements of more than 231% for a 5-mm pork aberrator and 703% for a 12-mm pork aberrator. With PIHI, improvements of 238% and 890% were observed for the two pork tissue samples. Our results suggest that the complementary contrast enhancement mechanism employed by the proposed method may be useful in improving imaging of technically difficult patients in clinics.

Stereotactic endovascular aortic navigation with a novel ultrasonic-based three-dimensional localization system.

BACKGROUND: Endovascular aortic procedures have been developed to treat many aortic diseases effectively. However, these procedures are also becoming increasingly complex given the development of branched or fenestrated endografts. Part of the difficulty lies in the limitations of current imaging paradigms. A more intuitive, three-dimensional (3D) mode of intraoperative imaging is desirable to accommodate the future progression of endovascular techniques. This article describes a novel endovascular catheter tracking device that uses ultrasonic signals, not ultrasound imaging. The tracking device displays real-time in vivo location on previously acquired 3D computed tomography (CT) images in an intuitive, endoluminal view. This system was tested in two swine and validated against fluoroscopy and by delivering stent grafts. METHODS: The ultrasonic-based localization system (ULS) provides real-time location information of a modified endovascular catheter and displays this location on preoperative 3D CT images. The 9F endovascular catheter has a small ultrasonic transmitter attached to its tip to signal its location to the ULS. Subsequent endovascular deployment of an aortic stent was carried out using only the ULS to target the stent placement position in the aorta of Yorkshire swine. System accuracy was measured against concurrent angiography as well as to deployed stents in situ. RESULTS: We successfully displayed the endovascular catheter tip location in real time along the registered CT aortic images, providing virtual endoluminal tracking. The relative accuracy of the ULS as compared with angiography for catheter movements in the abdominal aorta was found to have a mean error less than 1 mm. The ULS coordinates tracked within the lumen of the aortic image 98% of the time, as defined by the proportion of points within one radius distance of the aortic image centerline. Finally, three aortic stents were deployed using the ULS virtual image display to locate the target position in the aorta for stent deployment. Errors between target position and actual stent position ranged from -5.0 to +7.9 mm. CONCLUSIONS: This study demonstrates the feasibility of virtual image-guided endovascular aortic navigation using a ULS. This provides a 3D platform for virtual navigation on preoperative CT scan images during endovascular procedures that could assist in stent deployment as well as minimize or eliminate the need for procedural ionizing radiation and iodinated contrast. Future work will focus on miniaturization and refinements in accuracy that will be required to translate this technology into clinical application in endovascular procedures.

A 5-MHz cylindrical dual-layer transducer array for 3-D transrectal ultrasound imaging.

Two-dimensional transrectal ultrasound (TRUS) is being used in guiding prostate biopsies and treatments. In many cases, the TRUS probes are moved manually or mechanically to acquire volumetric information, making the imaging slow, user dependent, and unreliable. A real-time three-dimensional (3-D) TRUS system could improve reliability and volume rates of imaging during these procedures. In this article, the authors present a 5-MHz cylindrical dual-layer transducer array capable of real-time 3-D transrectal ultrasound without any mechanically moving parts. Compared with fully sampled 2-D arrays, this design substantially reduces the channel count and fabrication complexity. This dual-layer transducer uses PZT elements for transmit and P[VDF-TrFE] copolymer elements for receive, respectively. The mechanical flexibility of both diced PZT and copolymer makes it practical for transrectal applications. Full synthetic aperture 3-D data sets were acquired by interfacing the transducer with a Verasonics Data Acquisition System. Offline 3-D beamforming was then performed to obtain volumes of two wire phantoms and a cyst phantom. Generalized coherence factor was applied to improve the contrast of images. The measured -6-dB fractional bandwidth of the transducer was 62% with a center frequency of 5.66 MHz. The measured lateral beamwidths were 1.28 mm and 0.91 mm in transverse and longitudinal directions, respectively, compared with a simulated beamwidth of 0.92 mm and 0.74 mm.

Synergistic enhancements of ultrasound image contrast with a combination of phase aberration correction and dual apodization with cross-correlation.

Dual apodization with cross-correlation (DAX) is a novel adaptive beamforming technique which utilizes two distinct apodization functions in suppressing side lobes and clutter. Previous studies have shown that the performance of DAX in minimizing the effects of phase aberration diminishes with increasing aberrator strength. To achieve greater improvement in image contrast, we propose, in this paper, to combine DAX with a phase aberration correction algorithm based on nearest-neighbor cross-correlation (NNCC). Our simulation and experimental results presented in this work showed that the proposed method allows for synergistic enhancements of image contrast and achieves greater improvement in image quality than using DAX alone or phase aberration correction alone in the presence of weak and strong aberrators. Compared with standard delay-and-sum (DAS) beamforming, using the proposed method on simulated data with weak and strong aberrations increased the contrast-to-noise ratio (CNR) values from 4.10 to 10.96 and from 1.69 to 9.80, respectively. Experimental results were obtained using pork tissues of 4 and 10 mm thickness and a tissue-mimicking phantom. The CNR values increased from 3.74 to 9.72 for the 4-mm pork aberrator and from 1.27 to 8.17 for the 10-mm pork aberrator.

7.5 MHz dual-layer transducer array for 3-D rectilinear imaging.

The difficulties associated with fabrication and interconnection have limited the development of 2-D ultrasound transducer arrays with a large number ofelements (>5000). In previous work, we described a 5 MHz center frequency PZT-P[VDF-TrFE] dual-layer transducer that used two perpendicular 1-D arrays for 3-D rectilinear imaging. This design substantially reduces the channel count as well as fabrication complexity, which makes 3-D imaging more realizable. Higher frequencies (>5 MHz) are more commonly used in clinical applications or imaging targets near transducers, such as the breast, carotid and musculoskeletal tissue. In this paper, we present a 7.5 MHz dual-layer transducer array for 3-D rectilinear imaging. A modified acoustic stack model was designed and fabricated. PZT elements were sub-diced to eliminate lateral coupling. This sub-dicing process made the PZT into a 2-2 composite material, which could help improve transducer sensitivity and bandwidth. Full synthetic-aperture 3-D data sets were acquired by interfacing the transducer with a Verasonics data-acquisition system (VDAS). Offline 3-D beamforming was then performed to obtain volumes of a multiwire phantom and a cyst phantom. The generalized coherence factor (GCF) was applied to improve the contrast of cyst images. The measured -6 dB fractional bandwidth of the transducer was 71% with a center frequency of 7.5 MHz. The measured lateral beamwidths were 0.521 mm and 0.482 mm in azimuth and elevation, respectively, compared with a simulated beamwidth of 0.43 mm.

Design and in vitro evaluation of a real-time catheter localization system using time of flight measurements from seven 3.5 MHz single element ultrasound transducers towards abdominal aortic aneurysm procedures.

Interventional surgical instrument localization is a crucial component of minimally invasive surgery. Image guided surgery researchers are investigating devices broadly categorized as surgical localizers to provide real-time information on the instrument's 3D location and orientation only. This paper describes the implementation and in vitro evaluation of a prototype real-time nonimaging ultrasound-based catheter localizer system towards use in abdominal aortic aneurysm procedures. The catheter-tip is equipped with a single element ultrasound transducer which is tracked with an array of seven external single element transducers. The performance of the system was evaluated in a water tank and additionally in the presence of pork belly tissue and also a nitinol-dacron stent graft. The mean root mean square errors were respectively 1.94±0.06, 2.54±0.31 and 3.33±0.06 mm. In addition, this paper illustrates errors induced by transducer aperture size and suggests a method for aperture error compensation. Aperture compensation applied to the same experimental data yielded mean root mean square errors of 1.05±0.07, 2.42±0.33 and 3.23±0.07mm respectively for water; water and pork; and water, pork and stent experiments. Lastly, this paper presents a video showing free-hand movement of the catheter within the water tank with data capture at 25 frames per second.

Fresnel-based beamforming for low-cost portable ultrasound.

In this paper, we propose a modified electronic Fresnel-based beamforming method for low-cost portable ultrasound systems. This method uses a unique combination of analog and digital beamforming methods. Two versions of Fresnel beamforming are presented in this paper: 4-phase (4 different time delays or phase shifts) and 8-phase (8 different time delays or phase shifts). The advantage of this method is that a system with 4 to 8 transmit channels and 2 receive channels with a network of switches can be used to focus an array with 64 to 128 elements. The simulation and experimental results show that Fresnel beamforming image quality is comparable to traditional delay-and-sum (DAS) beamforming in terms of spatial resolution and contrast-to-noise ratio (CNR) under certain system parameters. With an f-number of 2 and 50% signal bandwidth, the experimental lateral beamwidths are 0.54, 0.67, and 0.66 mm and the axial pulse lengths are 0.50, 0.51, and 0.50 mm for DAS, 8-phase, and 4-phase Fresnel beamforming, respectively. The experimental CNRs are 4.66, 4.42, and 3.98, respectively. These experimental results are in good agreement with simulation results.

A high-frequency, high frame rate duplex ultrasound linear array imaging system for small animal imaging.

High-frequency (HF) ultrasound imaging has been shown to be useful for non-invasively imaging anatomical structures of the eye and small animals in biological and pharmaceutical research, achieving superior spatial resolution. Cardiovascular research utilizing mice requires not only realtime B-scan imaging, but also ultrasound Doppler to evaluate both anatomy and blood flow of the mouse heart. This paper reports the development of an HF ultrasound duplex imaging system capable of both B-mode imaging and Doppler flow measurements, using a 64-element linear array. The system included an HF pulsed-wave Doppler module, a 32-channel HF B-mode imaging module, a PC with a 200 MS/s 14-bit A/D card, and real-time LabView software. A 50 dB SNR and a depth of penetration of larger than 12 mm were achieved using a 35-MHz linear array with 50 µm pitch. The two-way beam widths were determined to be 165 to 260 µm and the clutter-energy-to-total-energy ratio (CTR) were 9.1 to 12 dB when the array was electronically focused at different focal points at depths from 4.8 to 9.6 mm. The system is capable of acquiring real-time B-mode images at a rate greater than 400 frames per second (fps) for a 4.8 x 13 mm field of view, using a 30- MHz 64-element linear array with 100 µm pitch. Sample in vivo cardiac high frame rate images and duplex images of mouse hearts are shown to assess its current imaging capability and performance for small animals.

3-D spatial compounding using a row-column array.

2-D spatial compounding has long been investigated to reduce speckle in ultrasound images. To further reduce speckle, several 3-D spatial compounding studies using 1-D and 1.5 D arrays with mechanical translation and position tracking have been reported. However, the fixed elevational focus and mechanical translation can degrade image quality in elevation. Using 2-D arrays, a better elevational resolution can be achieved with electronic focusing. Furthermore, 2-D arrays can generate greater number of independent images than 1-D arrays and the need for mechanical scanning is eliminated. In this paper, we present our 3-D spatial compounding images of two gel-based contrast phantoms and one resolution phantom. These images were acquired using a prototype 4 cm x 4 cm ultrasonic row-column prototype 2-D array operating at 5 MHz. Compounding nine decorrelated volumes showed a speckle signal-to-noise ratio (SNR) improvement of 2.68. The average improvement of the lesion contrast-to-noise ratio (CNR) was 2.45. However, using a smaller aperture to generate these volumes worsened the lateral resolution as predicted by theory.

Low-cost, high-speed back-end processing system for high-frequency ultrasound B-mode imaging.

For real-time visualization of the mouse heart (6 to 13 beats per second), a back-end processing system involving high-speed signal processing functions to form and display images has been developed. This back-end system was designed with new signal processing algorithms to achieve a frame rate of more than 400 images per second. These algorithms were implemented in a simple and cost-effective manner with a single field-programmable gate array (FPGA) and software programs written in C++. The operating speed of the back-end system was investigated by recording the time required for transferring an image to a personal computer. Experimental results showed that the back-end system is capable of producing 433 images per second. To evaluate the imaging performance of the back-end system, a complete imaging system was built. This imaging system, which consisted of a recently reported high-speed mechanical sector scanner assembled with the back-end system, was tested by imaging a wire phantom, a pig eye (in vitro), and a mouse heart (in vivo). It was shown that this system is capable of providing high spatial resolution images with fast temporal resolution.

A 256 x 256 2-D array transducer with row-column addressing for 3-D rectilinear imaging.

We present simulation and experimental results from a 5-MHz, 256 x 256 2-D (65,536 elements, 38.4 x 38.4 mm) 2-D array transducer with row-column addressing. The main benefits of this design are a reduced number of interconnects, a modified transmit/receive switching scheme with a simple diode circuit, and an ability to perform volumetric imaging of targets near the transducer with transmit beamforming in azimuth and receive beamforming in elevation. The final dimensions of the transducer were 38.4 mm x 38.4 mm x 300 microm. After a row-column transducer was prototyped, the series resonance impedance was 104 Omega at 5.4 MHz. The measured -6 dB fractional bandwidth was 53% with a center frequency of 5.3 MHz. The SNR at the transmit focus was measured to be 30 dB. At 5 MHz, the average nearest neighbor crosstalk was -25 dB. In this paper, we present 3-D images of both 5 pairs of nylon wires embedded in a clear gelatin phantom and an 8 mm diameter cylindrical anechoic cyst phantom acquired from a 256 x 256 2-D array transducer made from a 1-3 composite. We display the azimuth and elevation B-scans as well as the C-scan for each image. The cross-section of the wires is visible in the azimuth B-scan, and the long axes can be seen in the elevation B-scan and C-scans. The pair of wires with 1-mm axial separation is discernible in the elevational B-scan. When a single wire from the wire target phantom was used, the measured lateral beamwidth was 0.68 mm and 0.70 mm at 30 mm depth in transmit beamforming and receive beamforming, respectively, compared with the simulated beamwidth of 0.55 mm. The cross-section of the cyst is visible in the azimuth B-scan whereas the long axes can be seen as a rectangle in the elevation B-scan and C-scans.

Evaluating the robustness of dual apodization with cross-correlation.

We have recently presented a new method to suppress side lobes and clutter in ultrasound imaging called dual apodization with cross-correlation (DAX). However, due to the random nature of speckle, artifactual black spots may arise with DAX-processed images. In this paper, we present one possible solution, called dynamic DAX, to reduce these black spots. We also evaluate the robustness of dynamic DAX in the presence of phase aberration and noise. Simulation results using a 5 MHz, 128-element linear array are presented using dynamic DAX with aberrator strengths ranging from 25 ns root-mean-square (RMS) to 45 ns RMS and correlation lengths of 3 mm and 5 mm. When simulating a 3 mm diameter anechoic cyst, at least 100% improvement in the contrast-to-noise ratio (CNR) compared with standard beamforming is seen using dynamic DAX, except in the most severe case. Layers of pig skin, fat, and muscle were used as experimental aberrators. Simulation and experimental results are also presented using dynamic DAX in the presence of noise. With a system signal-to-noise ratio (SNR) of at least 15 dB, we have a CNR improvement of more than 100% compared with standard beamforming. This work shows that dynamic DAX is able to improve the contrast-to-noise ratio reliably in the presence of phase aberration and noise.