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Medical Ultrasound Imaging

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(a)

(b)

Figure 10.4 (a) Linear scan and image of a specular cylindrical reflector. (b) Linear scan with compounding of the same object. Compounding ‘fills in’ the nonimaged segments of the linear scan (Havlice and Taenzer [3] © IEEE)

usually much smaller in compound scanning than in simple sector scanning where angles as large as ±45are used. For illustrative purposes, only two positions in the linear travel and the respective sectors are shown in Figure 10.3. In compound scanning, object points are imaged by more than one acoustic pulse along different ray paths. Compound scanning is used to overcome a major problem in B-scan imaging, namely the difficulties of imaging specular reflectors and objects lying behind specular reflection. It is known that a specular reflector reflects sound towards a direction that is dependent on its orientation to the transducer. Hence, it is possible for any incident sound beam to reflect from a specular reflector in a direction such that the reflected sound beam does not reach to the transducer. The imaging system falsely interprets this as the absence of a reflector and does not display a signal even though a very strong reflecting interface may have been present. This is shown in Figure 10.4(a) for a simple linear scan of a cylindrical object (a blood vessel, for example). The sound that impinges on the side of the object is reflected away from the transducer so that it is never received. In this simple case, it is possible to mentally connect the two areas to form a mental image of the time object shape. However, in a complex biological medium, this is not always possible. The compound scan helps to ‘paint in’ that part of the specular surface that was not imaged in the simple scan. This is illustrated in Figure 10.4(b). Noted that only two positions of the

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transducers are shown for the linear travel along with the particular sector angle that images part of the side of the vessel. The compound scan is also useful for imaging behind highly reflecting or attenuating structure (i.e. ribs), since hidden object points can be imaged from an unobstructed direction.

10.3.1.1Resolution

Resolution here means spatial resolution. There are two types of spatial resolution in a B-scan:

(1) lateral or transverse resolution, resolution in the direction of transducer motion, and (2) axial resolution, resolution in the direction of a wave pulse propagation.

We consider first the lateral or transverse resolution. In a focused optical system, the resolution is defined by the Rayleigh criterion [16] which is determined by the light wavelength and the numerical aperture of the focusing elements through

δ =

1.22λF

(10.4)

D

where F is the focal length of the system and D is the diameter of the circular entrance pupil. For two incoherent point sources this criterion places the centre of the airy disc [16] of one source onto the first zero of the airy disc of the second source. The resulting intensity pattern has a 19% dip midway between the centres of the images of the two sources. Bringing the sources closer will cause this dip to fill in until only a central maximum is present and no obvious feature of the intensity pattern allows one to distinguish the presence of one source

from other.

The original purpose of Rayleigh formulated this resolution criterion was to predict the ability of an optical system to distinguish two self-luminous incoherent point sources (stars). For the optical system, it was operating in a receiver-only mode, whereas for the ultrasound B-scan systems, it operates in a transmit/receive mode. This mean that the effective spatial response of the ultrasound system to a point source reflector is the product of the transmitter field pattern with the receiver field pattern. Because the same transducer is usually employed for both transmit and receive, the effective spatial response pattern for a B-scan system is not an airy pattern, but the square of the airy pattern. This is illustrated in Figure 10.5. The zeros of the two functions still coincide, but the squared response function is sharper than the unsquared response.

This will affect resolutions. If one defines the criterion for resolution as the distance to the first zero of the propose function, then the resolution is identical to that calculated by Rayleigh [6]. As an example, for a 19-mm diameter, 2.25 MHz focused transducer with a 12-cm focal length, the Rayleigh resolution in a homogeneous medium such as water is about 5 mm at the focal distance. So far is lateral or transverse resolution. For axial resolution which is in the direction of acoustic pulse propagation, it is inferred from the arrival time of sequentially reflected acoustic pulses. It is relatively unaffected by the presence or absence of focusing elements but is determined principally by the bandwidth of the transducer [17]. The larger the bandwidth, the shorter the acoustic pulse that can be generated and received and the finer the definition along the axis of propagation.

In the presence of a wide bandwidth signal, the application of Rayleigh’s criterion is not straightforward. Rather than simply having a single wavelength λ, there is a wide spectrum of

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Relative power

1.0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0.9

 

 

 

4J 21

(x )

 

 

Airy pattern

 

 

 

 

 

 

 

 

 

 

 

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Airy pattern squared

 

 

 

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0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

2

3

4

5

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0

 

Transverse dimension x

Figure 10.5 Plot of the airy pattern and the square of the airy pattern. The ‘squared’ response has steeper slopes than the usual airy pattern, thus potentially increasing resolution (Havlice and Taenzer [3] © IEEE)

wavelength present. In a loss-free propagation medium, the transverse resolution can be estimated by using the wavelength of the minimal centre frequency of the transducer. The reason that this can be done is that, in the transverse dimension, the main effect of a broadband signal is to change (or eliminate) the side-lobe structure of the transducer field pattern. However, the body is not a loss-free propagation medium and as a result of having frequency-dependent absorption, the centre frequency of the sound field is not constant with depth of penetration. This is illustrated in Figure 10.6 for a 2.25 MHz transducer. Curve ‘a’ is the frequency spectrum (two-way response) for a pulse that was transmitted and received from a large plane reflector immersed in a nearly lossless medium (water). Curves ‘b’ and ‘c’ represent the calculated frequency spectrum of the same pulse after being reflected at a distance of 10 and 20 cm through tissue with an absorption coefficient of 1 dB cm−1 MHz−1. Note that the centre frequency decreases with increasing depth, thus adversely affecting the potential transverse resolution for deep structures.

There is another factor which negatively affects resolution. Most B-scanner achieves transverse resolution with fixed focus elements. Then the resolution is poorer for structure both

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Relative power (dB)

0

−5

−10

−15

−20

−25

−30

−35

−40

−45

1.4

1.8

2.2

2.6

3.0

3.4

1.0

Frequency (MHz)

Figure 10.6 Frequency spectrum of a transmitted/received echo from a broad band 2.25-MHz transducer. (a) Spectrum when signal propagates in a loss – free medium. (b) Spectrum when a signal is reflected at a 10-cm distance in a medium with a loss of 1 dB cm−1 MHz−1. (c) Spectrum when a signal is reflected at a 20-cm distance in a medium with a loss of 1 dB cm−1MHz−1 (Havlice and Taenzer [3] © IEEE)

nearer to and farther from the transducer than the focal length of the fixed focus element. In addition, the designer is faced with the following compromise: resolution at the focal depth may be improved by increasing the aperture (D in equation (10.4)). However, the depth of focus that region over which the optimum resolution is obtained, becomes smaller. This is unfortunate since the resolution improves only as the first power of the aperture, whereas the depth of focus becomes smaller as the square of the aperture [18]. In other words, one losses depth of focus much faster than one gains resolution. To minimize this effect only weak focusing is generally used in diagnostic instruments. Even so, the resolution is noticeably poorer for point far from the focal distance whenever fixed focus elements are used.

There are acoustic focusing elements that are not fixed in their focal distance but which are electronically variable [19–21]. It is possible to construct an electronically variable focusing devices because a piezoelectric transducer is sensitive not only to amplitude but also to phase [22]. This is unlike optical imaging where images are made by power detection that are phase

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insensitive. Electronically variable focusing devices have two forms: the annular array [23] in which the phase is processed on the assumption of circular symmetry and the linear array [24] in which the phase is processed on the assumption of one-dimensional (1D) symmetry. The former results in a focus similar to that obtained with a spherical lens. The latter results in a focus similar to that obtained with a cylindrical lens. A common denominator to both of these forms is that the transducer is subdivided into a number of independent units the signals to and from which are independently processed before being combined for the final image. The process involves some type of phase modification which is obtained either by differential time delay circuitry [25] or direct phase modulation [26]. The variable feature of the acoustic device arises from the ability to vary the electronic phase correction as fast as the acoustic data is received. Using these techniques, it is possible to obtain diffraction-limited resolution throughout the entire field of view of a B-scan image.

10.3.2C-Scan

C-scan provides a 2D orthographic image of an object. Unlike B-scan, where one dimension of the image is inferred from the arrival time of an acoustic pulse, time plays no primary role in either of the two image dimensions of a C-scan. In the transmission mode of C-scan, time plays a secondary role in that it determines the distance of the image plane from the transducer. A C-scan image resembles fluorescing images. Hence, they tend to look more familiar than a corresponding B-scan and are more readily interpretable. Figure 10.7 shows a block diagram of a simple mechanically driven transmission C-scan system. Here, an electronic pulse excites

 

 

 

SYNC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pulser

 

Pre-

 

 

Range

 

 

Image

Z-axis

 

 

 

gated

 

 

 

amplification

 

 

 

 

processing

 

 

 

 

 

 

amplifier

 

 

 

 

 

 

 

 

 

 

 

 

 

T/R switch

Only for

reflection C-scans

=1

X-axis

Position

indicator

Y-axis

=2

Figure 10.7 A block diagram of simple C-scan system (Havlice and Taenzer [3] © IEEE)

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Acoustical Imaging: Techniques and Applications for Engineers

a transducer which generates a burst of focused ultrasound that passes through an object to be imaged. The perturbed sound field is converted to an electronic signal by a receiving transducer which is in incorrect spatial registration with the transmitter. The signal is preamplified before passing through a range-gated amplifier which amplifies only the direct acoustic path signal.

Although our ultrasound in principle can be used in practice, multipath reverberation causes severe image degradations. This can be eliminated by combining the use of pulsed in-sonification with a range-gated receiving system. The range-gated signal is then processed for display by logarithm compression greyscale mapping. An example of a transmission mode C-scan image is given in Figure 10.8. This technique described is impractical for clinical use, since the image is generated over an extended period of time. Note that the image can also been obtained by keeping the transmitter/receiver fixed and move the object in a raster pattern or by flooding the entire object with a sound field and moving the receiver only.

Figure 10.8 C-scan transmission image of a full-term stillborn foetus (Havlice and Taenzer [3] © IEEE)

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The system shown in Figure 10.7 could also be used for reflection mode C-scan imaging by using transducer No. 1 scanned mechanically as before to obtain the 2D image. In this case, range gating not only removes multipath reverberations but also determines the distance of the image plane from the transducer.

Although the reflection mode and transmission mode C-scan techniques are similar, the resulting images are quite different. The reflection images, for instance, depend for their contrast primarily on acoustic impedance variations. They are particularly susceptible to specular reflections effects – small changes in object orientation often result in significantly different images. The transmission mode images depend for their contrast primarily on the differential attenuation properties of tissue. They are independent of specularity but are susceptible to coherent interference effects [27, 28].

The resolution of a C-scan system generally relies on the focusing properties of an acoustic lens for both displayed dimensions, the Rayleigh criterion given by equation (10.4) is a good estimate for definitions. In a C-scan system, the effective point response function may or may not be the square of the airy function, depending on the type of system used. This is in contrast to B-scans where the response function is almost always squared. In a C-scan image, both dimensions are lateral dimensions; hence, the bandwidth of the transducer is not a factor in resolution. Depth of focus is not a major, direct factor in C-scan resolution, but it has some significant indirect effects. For example, out of the focal plane objects may appear as out-of- focus artefacts in the images. As in B-scan, C-scan resolution also infers whenever ultrasound passes through tissue due to the frequency-dependent absorption coefficient [29].

10.4B-scan Instrumentation

B-scan instruments can be generally be classified into the following types.

10.4.1Manual Systems

The manual compound contact B-scan system has been the main story of diagnostic ultrasound imaging for many years. This form of ultrasound imaging system has evolved into sophisticated equipment capable of producing images with a significant degree of diagnostic information. Often manual B-scan equipment is used for diagnosing ailments in the region of the abdomen such as cystic and solid lesions [30], kidney and gall stones [31], carcinoma of the liver and uteral cirrhosis of the liver and for obstetrical applications such as placental localization [32] and the measurement of foetal biparietal diameter (BPD).

It is also beginning to be used for cardiac studies, imaging the thyroid gland, and in the pancreas and stomach. Indeed, as time progresses and equipment improves, the number of uses for the manual contact B-scan imaging system is ever expanding. Details of the operation of the compound contact B-scan system is given in Wells’ book [6].

Contact B-scan imaging system consists of three main parts: (1) a scanning arm to control the travel of an ultrasound transducer so that the ultrasound beam is always maintained in a single plane, (2) appropriate electronics for amplifying and detecting the returning echoes, monitoring the position and angle of the transducer and driving and deflecting a display device, and (3) a display to convert the electronic signals into an image on a CRT device. A block diagram of a typical manual contact B-scan system is shown in Figure 10.9. Ultrasonic coupling

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Acoustical Imaging: Techniques and Applications for Engineers

Scan arm

Transducer

Position

signals

Deflection

Ultrasonic circuits beam

Brightness

Transmitter

Receiver

Modulation

X deflection

Y deflection

 

 

Abdominal

Clock

Liver

wall

 

Kidney

CRT

Figure 10.9 A two-dimensional image of a cross section of the body can be produced with manual B- scan instruments. A typical system configuration includes the ultrasonic transducer which is mounted at the end of an articulated scan arm and which is moved by the technician or physician across the patient’s body. The position of the ultrasound beam is sensed by resolvers in the scan arm and the resulting position signals determine the position of the electron beam on the CRT. In this way, the ultrasonic echoes sensed by the transducer are used to build up the image (Havlice and Taenzer [3] © IEEE)

gel or mineral oil is first applied on to the patient’s skin. This is needed since ultrasound is highly attenuated in air. An operator grabs the transducer and places it against the patient. As he guides the transducer across the skin, the electronic circuits sense the angle and position of the scan arm and with that information, compute the angle and position of the ultrasound beam. As the transducer is moved, the electron beam in the CRT is deflected in a manner that makes each scan line in the image corresponds in angle and position to the ultrasound beam in the patient. Then an image is slowly built up of many scan lines. Depending on how the operator moves the transducer, linear, sector, arc or compound scanning can be accomplished. However, one of the limitations of this technique is that image quality can be affected by the manner in which the scanning is performed. Hence, ultrasound technologists must be trained to develop good scanning technique.

For the display device, several modern day scanners use a digital (solid-state) scan converter made up of semiconductor memory integrated circuits working in conjunction with electronic

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control circuits. In the digital scan converter, the image is usually broken into a matrix of points or ‘pixels’ and a memory ‘location’ is assigned to each pixel. A number corresponding to the brightness of each pixel is stored in its corresponding location as the scan is being made. As many as 512 × 512 points each with as many as 64 shades of grey (a six bit code) are used so that the solid-state memory may contain more than 1.5 million bits of information. The solidstate scan on centre is fast enough to produce images on a standard television monitor while at the same time storing the image. The operation is accomplished by changing the data only in those memory locations corresponding to newly scanned areas of the image while retaining previously recorded data in all the other memory locations. Thus, the operator is continuously presented with an image even though the scanning may take place slowly. Besides this, the digital scan converter does not suffer from the memory nonuniformity and drift problems of the analogue scan converter.

Some digital scan converters with limited numbers of pixels and shades of grey have suffered from quantization errors producing images which look contoured. However, this problem can be overcome by using more pixels and grey shades. The great flexibility of the solid-state approach makes it easy to achieve other capabilities such as zoom, greyscale mapping change, left/right image reversals, on-screen rotations for patients identification and date, and electronic calipers for measuring imaged structures. Two images obtained with a modern compound contact scanner with digital scan conversion are shown in Figure 10.10.

Figure 10.10 These two images made with a manual compound contact B-scanner show cystic structures within the liver. (a) Along with a large cyst in the upper right, normal liver tissue with vascular and hepatic structures shows clearly in this image made at 3.5 MHz. (b) In contrast, a severely diseased liver shows as a significantly different image. Notice how patient, date, and system information as well as distance calibration (the row of marks along the left edge of the image) are displayed directly on the image in modern scanners (Havlice and Taenzer [3] © IEEE)

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Acoustical Imaging: Techniques and Applications for Engineers

Because of its basic design, the manual contact scanner does give rise to certain problem. Since it works in contact with the patient, the skin and organ close to the skin are generally imaged poorly or not imaged at all because the receiver circuits require some time to recover from the large overload that occurs when the transmitter pulses the transducer. Typically, the first centimetre of the image is artefact not actually related to the tissues that are present. Since the scan is manually controlled, image quality varies with the expertise of the operator, and this operator dependence can be a significant problem. Not only must operator be trained before they can produce quality images, but manual scanning is slow and relatively tedious. A patient procedure takes a considerable length of time considering the few diagnostic images that are produced. During the relatively long time (1–10 s) that it takes to scan out a single image, organs can move causing the image to be distorted which, in turn, may confuse the diagnosis. Lastly, manual contact B-scanners do not display organ motions in real time.

10.4.2Real-Time System

Ultrasound image system which can produce image rapidly enough to display motion are called real-time system. In certain diagnostic procedures, the accurate display of tissue motion can be important for a proper diagnosis, such as the detection of diseased heart valves or the determination of foetal viability. In addition to being able to display organ motion, patient procedures can be accomplished very rapidly since little time is wasted in locating the organ or tissue of interest and the operator has nearly instantaneous positional feedback. In real-time system, the ultrasound beam is either mechanically or electronically scanned.

On the basis of the constraint that only one acoustic probe should be travelling in the field of interest at any instant in time, there is a constraint on real-time equipment given by

R · D · N =

v

(10.5)

2

where

R = maximum frame rate (s−1) D = depth of field (m)

N= number of scan lines

v = velocity of sound (m/s)

The velocity of sound is not significantly different for the various soft tissues of the body so that the product of frame rate, depth of field and number of scan lines is essentially a constant. For example, to get more scan lines in the image, either the frame rate or the depth of field must be decreased. Therefore, high-quality, real-time images are difficult to achieve for those organs such as the liver that require a large field of view.

10.4.3Mechanical Scan

Mechanical scan is the simplest technique for obtaining real-time images. The mechanical system replaces the human hand and moves the transducer automatically. Here, a motorized mechanism automatically reads or rotates the transducer while it is in contact with the patient’s skin [33, 34]. Position sensors continuously detect the angle of the transducer and produce a