Acoustic Radiation Forces at the Crossroads of Ultrasound Exposimetry, HIFU, and Elastography.

The applications of the acoustic radiation force (ARF) continue to multiply and extend from elastography into high-intensity focused ultrasound (HIFU), diagnostic imaging, lithotripsy, sonochemistry, levitation, and microsonics yet fundamental principles remain shrouded in mystery. A well-known and popular equation often used for calculating ARF in elastography is in conflict with the equation commonly employed for calculating ARF for determining acoustic power in radiation force balances (RFBs). Controversies have sparked debate for over a century concerning the physical mechanisms underlying ARFs. For over four decades, the science of ultrasound exposimetry has steadily improved and has provided clues in terms of accumulated data about the characteristics of transmitted ultrasound fields. Concurrently, the availability and capability of predicting these fields have improved significantly. The author draws on these sources to re-examine the physical principles behind ARFs. Conflicts are shown to stem from idealized configurations and simplistic assumptions. By more fully accounting for the pulse shape and spectrum, the effect of frequency power law attenuation, diffraction, and nonlinearity, more accurate equations are developed for ARFs for practical applications which are more consistent with exposimetry observations. Simulations compare well to corrected 1.5 MHz RFB data. While some questions await resolution, the approach presented here settles several longstanding conflicts and provides a new broadband framework for future ARF work.

Improved Color Doppler for Cerebral Blood Flow Axial Velocity Imaging.

Conventional color Doppler ultrasound imaging suffers from mutual frequency cancellation when applied to quantify axial blood flow velocities in the rodent brain where inverse flows exist within an ultrasound measurement voxel. Here, we report an improved color Doppler-based functional ultrasound imaging method (iCD-fUS) for axial blood flow velocity imaging of the rodent brain. By applying a directional filter and high frequency noise thresholding, iCD-fUS is able to accurately quantify blood flow velocities within the brain as validated with the ultrasound localization microscopy velocimetry method. We show that iCD-fUS is able to image and resolve the directional axial blood flow velocity throughout the entire coronal section of the brain at a temporal frame rate of up to 10 Hz with a spatial resolution of ~100 [Formula: see text]. We further applied iCD-fUS to image the axial blood flow velocity change in response to whisker stimulation in an awake mouse, showing its potential for studying brain activation. With these capabilities, iCD-fUS provides a powerful, quantitative tool for in vivo chronic research.

Functional Ultrasound Speckle Decorrelation-Based Velocimetry of the Brain.

A high-speed, contrast-free, quantitative ultrasound velocimetry (vUS) for blood flow velocity imaging throughout the rodent brain is developed based on the normalized first-order temporal autocorrelation function of the ultrasound field signal. vUS is able to quantify blood flow velocity in both transverse and axial directions, and is validated with numerical simulation, phantom experiments, and in vivo measurements. The functional imaging ability of vUS is demonstrated by monitoring the blood flow velocity changes during whisker stimulation in awake mice. Compared to existing Power-Doppler- and Color-Doppler-based functional ultrasound imaging techniques, vUS shows quantitative accuracy in estimating both axial and transverse flow speeds and resistance to acoustic attenuation and high-frequency noise.

Long-Duration Tracking of Cervical-Spine Kinematics With Ultrasound.

Cervical-spine (C-spine) pathoanatomy is commonly evaluated by plane radiographs, computed tomography (CT), or magnetic resonance imaging (MRI); however, these modalities are unable to directly measure the dynamic mechanical properties of the functional spinal units (FSU) comprising the C-spine that account for its functional performance. We have developed an ultrasound-based technique that provides a non-invasive, real-time, quantitative, in vivo assessment of C-spine kinematics and FSU viscoelastic properties. The fidelity of the derived measurements is predicated on accurate tracking of vertebral motion over a prolonged time duration. The purpose of this work was to present a bundle adjustment method that enables accurate tracking of the relative motion of contiguous cervical vertebrae from ultrasound radio-frequency data. The tracking method was validated using both a plastic anatomical model of a cervical vertebra undergoing prescribed displacements and also human cadaveric C-spine specimens subjected to physiologically relevant loading configurations. While the velocity of motion and thickness of the surrounding soft tissue envelope affected accuracy, using the bundle adjustment method, B-mode ultrasound was capable of accurately tracking vertebral motion under clinically relevant physiologic conditions. Therefore, B-mode ultrasound can be used to evaluate in vivo real-time C-spine kinematics and FSU mechanical properties in environments where radiographs, CT, or MRI cannot be used.

Conditionally Increased Acoustic Pressures in Nonfetal Diagnostic Ultrasound Examinations Without Contrast Agents: A Preliminary Assessment.

The mechanical index (MI) has been used by the US Food and Drug Administration (FDA) since 1992 for regulatory decisions regarding the acoustic output of diagnostic ultrasound equipment. Its formula is based on predictions of acoustic cavitation under specific conditions. Since its implementation over 2 decades ago, new imaging modes have been developed that employ unique beam sequences exploiting higher-order acoustic phenomena, and, concurrently, studies of the bioeffects of ultrasound under a range of imaging scenarios have been conducted. In 2012, the American Institute of Ultrasound in Medicine Technical Standards Committee convened a working group of its Output Standards Subcommittee to examine and report on the potential risks and benefits of the use of conditionally increased acoustic pressures (CIP) under specific diagnostic imaging scenarios. The term "conditionally" is included to indicate that CIP would be considered on a per-patient basis for the duration required to obtain the necessary diagnostic information. This document is a result of that effort. In summary, a fundamental assumption in the MI calculation is the presence of a preexisting gas body. For tissues not known to contain preexisting gas bodies, based on theoretical predications and experimentally reported cavitation thresholds, we find this assumption to be invalid. We thus conclude that exceeding the recommended maximum MI level given in the FDA guidance could be warranted without concern for increased risk of cavitation in these tissues. However, there is limited literature assessing the potential clinical benefit of exceeding the MI guidelines in these tissues. The report proposes a 3-tiered approach for CIP that follows the model for employing elevated output in magnetic resonance imaging and concludes with summary recommendations to facilitate Institutional Review Board (IRB)-monitored clinical studies investigating CIP in specific tissues.

Ultrasound transducer selection in clinical imaging practice.

Many types of medical ultrasound transducers are used in clinical practice. They operate at different center frequencies, have different physical dimensions, footprints, and shapes, and provide different image formats. However, little information is available about which transducers are most appropriate for a given application, and the purpose of this article is to address this deficiency. Specifically, the relationship between the transducer, imaging format, and clinical applications is discussed, and systematic selection criteria that allow matching of transducers to specific clinical needs are presented. These criteria include access to and coverage of the region of interest, maximum scan depth, and coverage of essential diagnostic modes required to optimize a patient's diagnosis. Three comprehensive figures organize and summarize the imaging planes, scanning modes, and types of diagnostic transducers to facilitate their selection in clinical diagnosis.

Tidal stretches do not modulate responsiveness of intact airways in vitro.

Studies on isolated tracheal airway smooth muscle (ASM) strips have shown that length/force fluctuations, similar to those likely occurring during breathing, will mitigate ASM contractility. These studies conjecture that, solely by reducing length oscillations on a healthy, intact airway, one can create airway hyperresponsiveness, but this has never been explicitly tested. The intact airway has additional complexities of geometry and structure that may impact its relevance to isolated ASM strips. We examined the role of transmural pressure (Ptm) fluctuations of physiological amplitudes on the responsiveness of an intact airway. We developed an integrated system utilizing ultrasound imaging to provide real-time measurements of luminal radius and wall thickness over the full length of an intact airway (generation 10 and below) during Ptm oscillations. First, airway constriction dynamics to cumulative acetylcholine (ACh) doses (10(-7) to 10(-3) M) were measured during static and dynamic Ptm protocols. Regardless of the breathing pattern, the Ptm oscillation protocols were ineffective in reducing the net level of constriction for any ACh dose, compared with the static control (P = 0.225-0.793). Next, Ptm oscillations of increasing peak-to-peak amplitude were applied subsequent to constricting intact airways under static conditions (5.0-cmH(2)O Ptm) with a moderate ACh dose (10(-5) M). Peak-to-peak Ptm oscillations < or = 5.0 cmH(2)O resulted in no statistically significant bronchodilatory response (P = 0.429 and 0.490). Larger oscillations (10 cmH(2)O, peak to peak) produced modest dilation of 4.3% (P = 0.009). The lack of modulation of airway responsiveness by Ptm oscillations in intact, healthy airways suggests that ASM level mechanisms alone may not be the sole determinant of airway responsiveness.

Imaging of the calf vocal fold with high-frequency ultrasound.

OBJECTIVES/HYPOTHESIS: High-frequency ultrasound imaging offers the potential for assisting in the diagnosis and treatment of vocal fold pathology if it allows aspects of vocal fold microstructure to be visualized noninvasively. The objective of this study was to assess the ability of high-frequency ultrasound to image vocal fold anatomy and injected biomaterials. STUDY DESIGN: The vocal folds of two excised calf larynges were imaged ex vivo and compared with corresponding histological sections. METHODS: High-frequency ultrasound imaging was performed under saline submersion using 40 and 50 MHz transducers, and corresponding cryostat cross-sections were stained with H&E, Trichome, and Verhoeff's Van Gieson stains. RESULTS: The epithelial surface, lamina propria, and underlying muscle were easily identified with the high-frequency ultrasound as verified with histological sections representing each imaged region. The arytenoid cartilage vocal process can also be clearly distinguished from the surrounding tissue, as can the full extent of injected biomaterials within the superficial lamina propria. Useful ultrasound resolution was obtained to depths of at least 10 mm within the tissue with the 40 MHz transducer. CONCLUSIONS: This preliminary study demonstrates the capability of high-frequency ultrasound to image the layered anatomy of the calf vocal fold and to discern materials injected into the superficial lamina propria, indicating that this technology holds a strong potential for use in phonosurgery.

Piezoelectric materials for imaging.

The purpose of this article is to present the reader with a brief description of those characteristics of piezoelectric materials that directly influence imaging.