Interobserver Agreement and Correlation of an Automated Algorithm for B-Line Identification and Quantification With Expert Sonologist Review in a Handheld Ultrasound Device.

OBJECTIVES: B-lines are ultrasound artifacts that can be used to detect a variety of pathologic lung conditions. Computer-aided methods to detect and quantify B-lines may standardize quantification and improve diagnosis by novice users. We sought to test the performance of an automated algorithm for the detection and quantification of B-lines in a handheld ultrasound device (HHUD). METHODS: Ultrasound images were prospectively collected on adult emergency department patients with dyspnea. Images from the first 124 patients were used for algorithm development. Clips from 80 unique subjects for testing were randomly selected in a predefined proportion of B-lines (0 B-lines, 1-2 B-lines, 3 or more B-lines) and blindly reviewed by five experts using both a manual and reviewer-adjusted process. Intraclass correlation coefficient (ICC) and weighted kappa were used to measure agreement, while an a priori threshold of an ICC (3,k) of 0.75 and precision of 0.3 were used to define adequate performance. RESULTS: ICC between the algorithm and manual count was 0.84 (95% confidence interval [CI] 0.75-0.90), with a precision of 0.15. ICC between the reviewer-adjusted count and the algorithm count was 0.94 (95% CI 0.90-0.96), and the ICC between the manual and reviewer-adjusted counts was 0.94 (95% CI 0.90-0.96). Weighted kappa was 0.72 (95% CI 0.49-0.95), 0.88 (95% CI 0.74-1), and 0.85 (95% CI 0.89-0.96), respectively. CONCLUSIONS: This study demonstrates a high correlation between point-of-care ultrasound experts and an automated algorithm to identify and quantify B-lines using an HHUD. Future research may incorporate this HHUD in clinical studies in multiple settings and users of varying experience levels.

Quantitative Sound Speed Imaging of Cortical Bone and Soft Tissue: Results From Observational Data Sets.

This work presents the first quantitative ultrasonic sound speed images of ex vivo limb cross-sections containing both soft tissue and bone using Full Waveform Inversion (FWI) with level set (LS) and travel time regularization. The estimated bulk sound speed of bone and soft tissue are within 10% and 1%, respectively, of ground truth estimates. The sound speed imagery shows muscle, connective tissue and bone features. Typically, ultrasound tomography (UST) using FWI is applied to imaging breast tissue properties (e.g. sound speed and density) that correlate with cancer. With further development, UST systems have the potential to deliver volumetric operator independent tissue property images of limbs with non-ionizing and portable hardware platforms. This work addresses the algorithmic challenges of imaging the sound speed of bone and soft tissue by combining FWI with LS regularization and travel time methods to recover soft tissue and bone sound speed with improved accuracy and reduced soft tissue artifacts when compared to conventional FWI. The value of leveraging LS and travel time methods is realized by evidence of improved bone geometry estimates as well as promising convergence properties and reduced risk of final model errors due to un-modeled shear wave propagation. Ex vivo bulk measurements of sound speed and MRI cross-sections validates the final inversion results.

Full noncontact laser ultrasound: first human data.

Full noncontact laser ultrasound (LUS) imaging has several distinct advantages over current medical ultrasound (US) technologies: elimination of the coupling mediums (gel/water), operator-independent image quality, improved repeatability, and volumetric imaging. Current light-based ultrasound utilizing tissue-penetrating photoacoustics (PA) generally uses traditional piezoelectric transducers in contact with the imaged tissue or carries an optical fiber detector close to the imaging site. Unlike PA, the LUS design presented here minimizes the optical penetration and specifically restricts optical-to-acoustic energy transduction at the tissue surface, maximizing the generated acoustic source amplitude. With an appropriate optical design and interferometry, any exposed tissue surfaces can become viable acoustic sources and detectors. LUS operates analogously to conventional ultrasound but uses light instead of piezoelectric elements. Here, we present full noncontact LUS results, imaging targets at ~5 cm depths and at a meter-scale standoff from the target surface. Experimental results demonstrating volumetric imaging and the first LUS images on humans are presented, all at eye- and skin-safe optical exposure levels. The progression of LUS imaging from tissue-mimicking phantoms, to excised animal tissue, to humans in vivo is shown, with validation from conventional ultrasound images. The LUS system design insights and results presented here inspire further LUS development and are a significant step toward the clinical implementation of LUS.

Characterization of laser ultrasound source signals in biological tissues for imaging applications.

Short optical pulses emitted from a tunable Q-switched laser (800 to 2000 nm) generate laser ultrasound (LUS) signals at the surface of biological tissue. The LUS signal's acoustic frequency content, dependence on sample type, and optical wavelength are observed in the far field. The experiments yield a reference dataset for the design of noncontact LUS imaging systems. Measurements show that the majority of LUS signal energy in biological tissues is within the 0.5 and 3 MHz frequency bands and the total acoustic energy generated increases with the optical absorption coefficient of water, which governs tissue optical absorption in the infrared range. The experimental results also link tissue surface roughness and acoustic attenuation with limited LUS signal bandwidth in biological tissue. Images constructed using 810-, 1064-, 1550-, and 2000-nm generation laser wavelengths and a contact piezoelectric receiver demonstrates the impact of the generation laser wavelength on image quality. A noncontact LUS-based medical imaging system has the potential to be an effective medical imaging device. Such a system may mitigate interoperator variability associated with current medical ultrasound imaging techniques and expand the scope of imaging applications for ultrasound.

A single element 3D ultrasound tomography system.

Over the past decade, substantial effort has been directed toward developing ultrasonic systems for medical imaging. With advances in computational power, previously theorized scanning methods such as ultrasound tomography can now be realized. In this paper, we present the design, error analysis, and initial backprojection images from a single element 3D ultrasound tomography system. The system enables volumetric pulse-echo or transmission imaging of distal limbs. The motivating clinical applications include: improving prosthetic fittings, monitoring bone density, and characterizing muscle health. The system is designed as a flexible mechanical platform for iterative development of algorithms targeting imaging of soft tissue and bone. The mechanical system independently controls movement of two single element ultrasound transducers in a cylindrical water tank. Each transducer can independently circle about the center of the tank as well as move vertically in depth. High resolution positioning feedback (~1µm) and control enables flexible positioning of the transmitter and the receiver around the cylindrical tank; exchangeable transducers enable algorithm testing with varying transducer frequencies and beam geometries. High speed data acquisition (DAQ) through a dedicated National Instrument PXI setup streams digitized data directly to the host PC. System positioning error has been quantified and is within limits for the imaging requirements of the motivating applications.