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Purpose: Test objects for High Intensity Focused Ultrasound (HIFU) are required for the standardization and definition of treatment, Quality Assurance (QA), comparison of results between centers and calibration of devices. This study describes a HIFU test object which provides temperature measurement as a function of time, in a reference material compatible with Magnetic Resonance (MR) and ultrasound. Materials and methods: T-Type fine wire thermocouples were used as sensors and 5 correction methods for viscous heating artifacts were assessed. The phantom was tested in a MR-HIFU Philips Sonalleve device over a period of 12 months, demonstrating stability and validity to evaluate the performance of the device. Results: The study furnished useful information regarding the MR-HIFU sessions and highlighted potential limitations of the existing QA and monitoring methods. The importance of temperature monitoring along the whole acoustic path was demonstrated as MR Thermometry readings differed in the three MR plane views (coronal, sagittal, transverse), in particular when the focus was near a soft-tissue/bone interface, where there can be an MR signal loss with significant temperature and thermal dose underestimation (138% variation between the three plane views). Conclusions: The test object was easy to use and has potential as a valid tool for training, QA, research and development for MR guided HIFU and potentially ultrasound guided devices. [ABSTRACT FROM AUTHOR]

Dual-beam vector Doppler has the potential to improve peak systolic blood velocity measurement accuracy by automatically correcting for the beam-flow Doppler angle. Using a modified linear-array system with a split receive aperture, we have assessed the angle-dependence over Doppler angles of 40°–70° and the reproducibility of the dual-beam blood maximum velocity estimate measured in the common carotid arteries (CCA) 1 to 2 cm prior to the bifurcation of 9 presumed-healthy volunteers. The velocity magnitude estimate was reduced by approximately 7.9% as the angle between the transmit beam and the vessel axis was increased from 40° to 70°. With repeat measurements made, on average, approximately 6 weeks apart, the 95% velocity magnitude limits of agreement were as follows: Intraobserver −41.3 to +45.2 cm/s; interobserver −29.6 to +46.8 cm/s. There was an 8.6 cm/s interobserver bias in velocity magnitude. We conclude that the dual-beam vector Doppler system can measure blood velocity within its scan plane with low dependence on angle and with similar reproducibility to that of single-beam systems. (E-mail: robins@maths.usyd.edu.au) [Copyright &y& Elsevier]

Ultrasound (US) test phantoms incorporating tissue-mimicking materials (TMMs) play an important role in the quality control (QC) and performance testing of US equipment. Three commercially available TMMs (ZerdineTM from CIRS Inc.; condensed-milk-based gel from Gammex RMI; urethane-rubber-based from ATS Labs) and a noncommercial agar-based TMM, were investigated. Acoustic properties were measured over the frequency range 2.25 to 15 MHz at a range of ambient temperatures (10 to 35°C). The acoustic velocity of the TMMs remained relatively constant with increasing frequency. Only the agar-based TMM had a linear increase of attenuation with frequency, with the other materials exhibiting nonlinear responses to varying degrees (f1.08 to f1.83). The acoustic velocity and attenuation coefficient of all the TMMs varied with temperature, with the urethane-rubber TMM showing the greatest variation of ± 1.2% for acoustic velocity and ± 12% for attenuation coefficient. The data obtained in this study highlight the importance of greater knowledge of the acoustic behavior of TMMs to variations in both frequency and temperature, to ensure that accurate and precise measurements are obtained during QC and performance testing. (E-mail: jacinta.browne@northglasgow.scot.nhs.uk) [Copyright &y& Elsevier]

Introduction: During prostate radiotherapy treatment, it is important to ensure the position of the bladder and prostate is consistent between treatments. The aim of this study was to provide a quantitative basis for incorporating ultrasound bladder volume estimates into local practice for prostate radiotherapy., Methods: Agreement between bladder volume estimates obtained using computed tomography (CT) and ultrasound was assessed. Analysis of bladder volumes between planning and treatment scans was used to quantify expected variations in bladder volume over the course of radiotherapy. Dose-volume statistics were estimated and compared to planned dose constraints to propose a target bladder volume and tolerance., Results: Bladder volume measurements were obtained from 19 radiotherapy patients using ultrasound and CT. Ultrasound underestimated bladder volume compared to CT with a mean bias of -28 ± 30 ml. Pre-treatment (planning) bladder volumes varied from 71 to 383 ml with a mean of 200 ml. Treatment bladder volumes reduced by more than half in 9% of patients during the course of their treatment, potentially leading to a 30% increase in mean bladder dose. Patients with pre-treatment bladder volumes < 200 ml were most likely to exhibit differences in bladder volume, resulting in 'out of tolerance' increases in dose., Conclusions: A pragmatic individualised drinking protocol, aimed at achieving a minimum ultrasound bladder volume of 200 ml at planning CT, may be beneficial to reproducibility in radiotherapy treatment. Ultrasound measurements prior to treatment should ideally confirm that bladder volume is at least half the volume measured at planning., (© The Author(s) 2021.)

Purpose: The purpose of this study was to determine the efficacy of a novel ultrasound-based carotid plaque risk index (CPRI) in predicting the presence of cerebrovascular symptoms in patients with carotid artery stenosis., Materials and Methods: This was a cross-sectional, observational study involving 56 patients (mean age 76.6 years, 62.5 % male). Plaque grayscale median (GSM) and surface irregularity indices (SII) were measured in 82 stenosed carotid arteries (range 10 - 95 %) and combined with the degree of stenosis (DOS) in the form of (DOS*SII)/(1 + GSM). A reduced index DOS/(1 + GSM) not incorporating plaque surface irregularities was also investigated. Receiver operating characteristic curves (ROC) were used to study the diagnostic efficacy of CPRI, comparing against DOS and an equivalent risk index constructed using a conventional logistic regression based method with model parameters optimized to the dataset (CPRIlogistic)., Results: There were 42 stenosed carotid arteries with cerebrovascular symptoms, and 40 without symptoms. The presence of symptoms significantly correlated with DOS, GSM and SII (p < 0.01). The median CPRI of the symptomatic (asymptomatic) groups were 23.2 (9.2) compared with 0.71 (0.30) for CPRIlogistic (p < 0.01). The diagnostic performance of CPRI exceeded that of CPRIlogistic and DOS, and demonstrated a better separation of the symptomatic and asymptomatic groups., Conclusion: Our novel risk index combines quantitative measures of carotid plaque echogenicity and surface irregularities with the degree of stenosis. It is a better predictor of cerebrovascular symptoms than the degree of stenosis and could be valuable in studies and clinical trials aimed at identifying vulnerable carotid artery stenoses., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: There is a need to develop methods that reliably quantify characteristics associated with vulnerable carotid plaque. Greyscale median (GSM) and shear wave elastography (SWE) are two techniques that may improve individual plaque risk stratification. SWE, which quantifies Young's Modulus (YM) to estimate tissue stiffness, has been researched in the liver, breast, thyroid and prostate, but its use in carotid plaques is novel., Materials and Methods: The aim of this study was to quantify YM and GSM of plaques and compare to histology. 25 patients (64% male) with a mean age of 76 underwent both clinical and SWE imaging. The mean GSM was quantified over a cardiac cycle. The mean YM was quantified in multiple regions within the plaque over 5 frames. Histological features were assessed following carotid endarterectomy., Results: The mean YM of unstable plaques was significantly lower than that of stable plaques (50.0 kPa vs. 79.1 kPa; p = 0.027). The presence of intra-plaque hemorrhage, thrombus and increasing numbers of foam cells was also associated with a significantly lower YM. Plaque YM did not correlate well with plaque GSM (r =  .12). The mean plaque GSM was the same in both unstable and stable plaques. Fibrous plaques had a significantly higher GSM (p = 0.036)., Conclusion: In conclusion, SWE provides additional information on plaque stiffness which may be of clinical benefit to help identify vulnerable plaque, and warrants further study., (© Georg Thieme Verlag KG Stuttgart · New York.)

Doppler ultrasound is widely used in the diagnosis and monitoring of arterial disease. Current clinical measurement systems make use of continuous and pulsed ultrasound to measure blood flow velocity; however, the uncertainty associated with these measurements is great, which has serious implications for the screening of patients for treatment. Because local blood flow dynamics depend to a great extent on the geometry of the affected vessels, there is a need to develop anatomically accurate arterial flow phantoms with which to assess the accuracy of Doppler blood flow measurements made in diseased vessels. In this paper, we describe the computer-aided design and manufacturing (CAD-CAM) techniques that we used to fabricate anatomical flow phantoms based on images acquired by time-of-flight magnetic resonance imaging (TOF-MRI). Three-dimensional CAD models of the carotid bifurcation were generated from data acquired from sequential MRI slice scans, from which solid master patterns were made by means of stereolithography. Thereafter, an investment casting procedure was used to fabricate identical flow phantoms for use in parallel experiments involving both laser and Doppler ultrasound measurement techniques.

A nonplanar wall-less anatomical flow phantom of a healthy human carotid artery is described, the construction of which is based on a lost-core technique described in the companion paper (Part I) by . The core was made by rapid prototyping of an idealized three-dimensional computer model of the carotid artery. Flow phantoms were built using these idealized non planar carotid artery bifurcations. Physiologically realistic flow waveforms were produced with resistance index values of 0.75, 0.72 and 0.63 in the common, external and internal carotid artery branches, respectively. Distension of the common carotid using M-mode imaging was found to be at 10% of diameter. Although differences in vessel diameter between the phantom and that of the original computer model were statistically significant (p < 0.05), there was no difference (p > 0.05) in measurements made on the lost-cores and those obtained by B-mode ultrasound on the resulting flow phantoms. In conclusion, it was possible to reliably reproduce geometrically similar anatomical flow phantoms that are capable of producing realistic physiological flow patterns and distensions.

Numerical simulations of pulsatile blood flow in straight tube stenosis models were performed to investigate the poststenotic flow phenomena. In this study, three axisymmetrical and three asymmetrical stenosis models with area reduction of 25%, 50% and 75% were constructed. A measured human common carotid artery blood flow waveform was used as the upstream flow condition which has a mean Reynold's number of 300. All calculations were performed with high spatial and temporal resolutions. Flow features such as velocity profiles, flow separation zone (FSZ), and wall shear stress (WSS) distributions in the poststenotic region for all models are presented. The results have demonstrated that the formation and development of FSZs in the poststenotic region are very complex, especially in the flow deceleration phase. In axisymmetric stenoses the poststenotic flow is more sensitive to changes in the degree of stenosis than in asymmetric models. For severe stenoses, the stenosis influence length is shorter in asymmetrical models than in axisymmetrical cases. WSS oscillations (between positive and negative values) have been observed at various downstream locations in some models. The amplitude of the oscillation depends strongly on the axial location and the degree of stenosis.

Wall-less flow phantoms are preferred for ultrasound (US) because tissue-mimicking material (TMM) with good acoustical properties can be made and cast to form anatomical models. The construction and geometrical stability of wall-less TMM flow phantoms is described using a novel method of sealing to prevent leakage of the blood-mimicking fluid (BMF). Wall-less stenosis flow models were constructed using a robust agar-based TMM and sealed using reticulated foam at the inlet and outlet tubes. There was no BMF leakage at the highest flow rate of 2.8 L/min in 0%, 35% and 57% diameter reduction stenoses models. Failure of the 75% stenosis model, due to TMM fracture, occurred at maximum flow rate of 2 L/min (mean velocity 10 m/s within the stenosis). No change of stenosis geometry was measured over 4 days. The construction is simple and effective and extends the possibility for high flow rate studies using robust TMM wall-less phantoms.

Objective: To assess the vascularisation of focal hepatic tumours using NC100100, enhanced power Doppler imaging., Methods: Twenty-two patients with focal liver tumours (12 metastases and ten hemangiomas) were studied. Using standardised settings, power Doppler imaging with ATL HDI3000 was performed before and after intravenous administration of NC100100 contrast agent. The video-recorded examinations were digitised for off-line analysis on a personal computer. Regions of interest were defined over the entire tumour and a neighbouring area of the normal liver parenchyma. The temporal changes of the mean power Doppler signal intensity (PDSI) was quantified to provide contrast agent wash-in (PDSI-time) curves for the initial 40 s., Results: Liver metastases were characterised by a rapid increase in PDSI, while the PDSI-time curves within hemangiomas were flat. The PDSI within the tumour increased significantly in ten subjects with liver metastases and only one subject with hemangioma. An enhanced rim around hemangiomas was seen in four subjects. There was no clear relationship between the contrast agent dose and the peak PDSI within metastases., Conclusions: Power Doppler imaging with NC100100 contrast agent enhances tumour visualisation and may aid differential diagnosis of focal liver lesions.

The Doppler backscatter properties of a blood-mimickig fluid (BMF) were studied to evaluate its suitability for use in a Doppler flow test object. Measurements were performed using a flow rig with C-flex tubing and BMF flow produced by a roller pump or a gear pump. A SciMed Doppler system was used to measure the backscattered Doppler power with a root-mean-square power meter connected to the audio output. Studies investigated the dependence of the backscattered Doppler power of the BMF with: circulation time; batch and operator preparations; storage; sieve size; flow speed; and pump type. A comparison was made with human red blood cells resuspended in saline. The backscatter properties are stable and within International Electrotechnical Commission requirements. The BMF is suitable for use in a test object for Doppler performance assessment.

Whole-embryo culture was used as the model system to study the effects of pulsed ultrasound on embryonic development. Rat embryos (9.5 days old) were exposed to a wide range of ultrasound levels at ultrasound frequencies between 1-4 MHz for 30 min in vitro. After 48 h in culture, absolute control, sham and treatment embryos were assessed for viability, morphology, growth and development. At an ambient temperature of 37 degrees C, no significant effects were observed for spatial peak temporal average intensities below 4 W/cm2 or peak negative pressures below 1.9 MPa. At higher acoustic levels, there was a significant increase in the number of nonviable embryos and the number of morphological abnormalities in viable embryos increased. Abnormal cephalocaudal flexion and abnormal head development were the most common gross morphological abnormalities. Both thermal and nonthermal bioeffect mechanisms are involved.

A blood-mimicking fluid (BMF) suitable for use in Doppler flow test objects is described and characterised. The BMF consists of 5 microns diameter nylon scattering particles suspended in a fluid base of water, glycerol, dextran and surfactant. The acoustical properties of various BMF preparations were measured under uniform flow to study the effects of particle size, particle concentration, surfactant concentration, flow rate and stability. The physical properties, (density, viscosity and particle size), and acoustical properties (velocity, backscatter and attenuation) of the BMF are within draft International Electrotechnical Commission requirements.

Doppler test objects are used to characterise Doppler systems, both stand-alone systems and the Doppler part of so-called duplex scanners. The aim of the project partially presented here is the development and validation of an example of a Doppler test object fulfilling the requirements of the IEC 1685. The project has been carried out by nine partners of five European countries and has been funded by the European Commission. The flow Doppler test object is composed of: tissue mimicking material (TMM), blood mimicking fluid (BMF), tube (embedded in the TMM and carrying the BMF), tank flow system, including a pump and a flow meter. In the normative part of the IEC 1685, requirements are given for the values of acoustical parameters of TMM and BMF such as sound velocity, attenuation and backscattering. For BMF, requirements are given also for values of density and viscosity. In an informative (but not compulsory) annex, a description is given of a flow test object meeting these requirements as an example. 'example test object' developed during the project is composed of TMM based on agar and including SiC- and Al2O3-powders, BMF based on nylon particles suspended in water and glycerine, and a tube of c-flex, a silicon copolymer. Two tube sizes are used: 4.0 mm ID and 8.0 mm ID. During the project, very precise recipes have been developed for the composition and preparation of both TMM and BMF. Based on these recipes and a description of the construction in a design five flow test objects have been constructed in the laboratories of five participants. The test objects have been compared by measurements of the physical parameters and by Doppler measurements of the five test objects with the Doppler system. The measurements have been carried out by five observers. Inter-test object and inter-observer variabilities are determined, yielding information about usefulness of the parameters.

Layered tissue models are developed to estimate in situ ultrasound intensity during common obstetric examinations by incorporation of measured overlying tissue thicknesses with data on the attenuation properties of tissues. Results are compared with attenuation models recommended by the United States Food and Drug Administration (FDA) and National Council on Radiation Protection and Measurements (NCRP). For abdominal and transvaginal scanning in the first trimester, fixed attenuation models based on attenuation values of 1.2 dB/MHz and 0.6 dB/MHz, respectively, are representative of worst-case exposure conditions. For second and third trimesters, a fixed attenuation value of 0.8 dB/MHz is representative of worst-case exposure conditions. A fixed attenuation value of 1.0 dB/MHz is suggested for common Doppler examinations. The study suggests that the FDA-derating factor of 0.3 dB/cm.MHz may not give a conservative estimate of in situ intensity for certain obstetric examinations.