Ultrasound tomography (UST) is an emerging breast imaging modality that produces quantitative volumetric measurements of breast density without using ionizing radiation. Waveform reconstructions of UST sound speed images produce higher resolution maps of density distributions and has been shown to better separate dense tissue from non-dense tissue than ray based reconstructions. Volpara produces automated measures of volumetric mammographic density. Women who underwent both a UST scan and had a Volpara reading of their mammographic breast density had their density measures compared. Waveform sound speed images were reconstructed from the UST raw data and these images were then separated into regions of dense and non-dense tissue using a k-means clustering algorithm. This allowed for quantitative volumetric measures of average breast density along with subregion density measures. After preliminary analysis, correlations between the UST density measures and Volpara density measures were strong. In particular, the waveform density measures showed slightly stronger correlations with Volpara than the previous ray-based reconstructions, especially for direct measures of dense tissue. Further analysis is still required but this potentially indicates that waveform sound speed images are able to more clearly separate dense and non-dense regions of breast tissue.
Both mammography and standard ultrasound (US) rely upon subjective criteria within the breast imaging reporting and data system (BI-RADS) to provide more uniform interpretation outcomes, as well as differentiation and risk stratification of associated abnormalities. In addition, the technical performance and professional interpretation of both tests suffer from machine and operator dependence. Breast MR has become the new gold standard for screening of high-risk women but has cost and access limitations in extending screening to the entire population. We have been developing a new technique for breast imaging that is based on ultrasound tomography which quantifies tissue characteristics while also producing 3-D images of breast anatomy. Results are presented from clinical studies that utilize this method.
Informed consent was obtained from all patients, prospectively recruited in an IRB-approved protocol following HIPAA guidelines. Images were produced by tomographic algorithms for reflection, sound speed and attenuation. All images were reviewed by a board-certified radiologist who has more than 20 years of experience in breast imaging and US-technology development. In the first phase of the study, UST images were compared to multi-modal imaging to determine the appearance of lesions and breast parenchyma. In the second phase of the study, correlative comparisons with MR breast imaging were used to establish basic operational capabilities of the UST system including the identification and characterization of parenchymal patterns. Our study demonstrated a high degree of correlation of breast tissue structures relative to fat subtracted contrast enhanced MRI. With a scan duration of ~ 1-3 minutes, no significant motion artifacts were observed.
Mammography is not sufficiently effective for women with dense breast tissue – women who are at much higher risk for developing breast cancer. Consequently, many breast cancers go undetected at their treatable stage. Improved cancer detection and characterization for women with dense breast tissue is urgently needed. Our clinical study has shown that ultrasound tomography (UST) is an emerging technique that moves beyond B-mode imaging by its through transmission capabilities. Transmission ultrasound provides additional tissue parameters such as sound speed, attenuation, and through-transmission rendered tissue stiffness information. For women with dense breasts, these parameters can be used to assist in detecting malignant masses within glandular or fatty tissue and differentiating malignant and benign masses. This paper focuses on the use of waveform ultrasound sound speed imaging and tissue stiffness information generated using through-transmission data to characterize different breast tissues and breast masses. In-vivo examples will be given to assess its effectiveness.
Ultrasound tomography (UST) is an emerging modality that can offer quantitative measurements of breast density.
Recent breakthroughs in UST image reconstruction involve the use of a waveform reconstruction as opposed to a raybased
reconstruction. The sound speed (SS) images that are created using the waveform reconstruction have a much
higher image quality. These waveform images offer improved resolution and contrasts between regions of dense and
fatty tissues. As part of a study that was designed to assess breast density changes using UST sound speed imaging
among women undergoing tamoxifen therapy, UST waveform sound speed images were then reconstructed for a
subset of participants. These initial results show that changes to the parenchymal tissue can more clearly be visualized
when using the waveform sound speed images. Additional quantitative testing of the waveform images was also
started to test the hypothesis that waveform sound speed images are a more robust measure of breast density than
ray-based reconstructions. Further analysis is still needed to better understand how tamoxifen affects breast tissue.
Ultrasound tomography (UST) is an emerging breast imaging modality that can be used to quantitatively measure breast
density. However, the sound speed images that are used in this analysis must first be segmented in order to accurately
parse any quantitative information. Previously, this segmentation has been done manually, but this is time consuming,
especially when dealing with a large number of images that must be masked. An automated masking algorithm has been
developed that applies thresholding and morphological operators to UST attenuation images to automatically create
masks that separate the breast tissue from the water bath. An initial set of images was tested using this algorithm to
fine tune settings and very good agreement was achieved. However, when the optimized settings were applied to a
larger dataset of 286 images, the robustness of the algorithm was tested. The manual masks measured a larger volume
(921 cm3) than the automated masks (713 cm3), but fortunately, the difference in mean sound speed was much smaller
(1449 m/s versus 1448 m/s). A majority of the automated masks (72.7%) had a measured Dice similarity coefficient (DSC)
of greater than 0.8 which indicates that there was good to great overlap in the volumes of tissue created by the
automated method. This algorithm shows promise to be used as a tool to quickly and effectively measure breast density.
Women with high breast density are at increased risk of developing breast cancer. Breast density has usually been defined using mammography as the ratio of fibroglandular tissue to total breast area. Ultrasound tomography (UST) is an emerging modality that can also be used to measure breast density. UST creates tomographic sound speed images of the patient’s breast which is useful as sound speed is directly proportional to tissue density. Furthermore, the volumetric and quantitative information contained in the sound speed images can be used to describe the distribution of breast density. The work presented here measures the UST sound speed density distributions of 165 women with negative screening mammography. Frequency distributions of the sound speed voxel information were examined for each patient. In a preliminary analysis, the UST sound speed distributions were averaged across patients and grouped by various patient and density-related factors (e.g., age, body mass index, menopausal status, average mammographic breast density). It was found that differences in the distribution of density could be easily visualized for different patient groupings. Furthermore, findings suggest that the shape of the distributions may be used to identify participants with varying amounts of dense and non-dense tissue.
Women with elevated mammographic percent density, defined as the ratio of fibroglandular tissue area to total breast area on a mammogram are at an increased risk of developing breast cancer. Ultrasound tomography (UST) is an imaging modality that can create tomographic sound speed images of a patient’s breast, which can then be used to measure breast density. These sound speed images are useful because physical tissue density is directly proportional to sound speed. The work presented here updates previous results that compared mammographic breast density measurements with UST breast density measurements within an ongoing study. The current analysis has been expanded to include 158 women with negative digital mammographic screens who then underwent a breast UST scan. Breast density was measured for both imaging modalities and preliminary analysis demonstrated strong and positive correlations (Spearman correlation coefficient rs = 0.703). Additional mammographic and UST related imaging characteristics were also analyzed and used to compare the behavior of both imaging modalities. Results suggest that UST can be used among women with negative mammographic screens as a quantitative marker of breast density that may avert shortcomings of mammography.
KEYWORDS: Breast, Cancer, Tissues, Ultrasonography, In vivo imaging, Mammography, Elastography, Signal attenuation, Ultrasound tomography, Imaging systems
A number of clinical trials have shown that screening ultrasound, supplemental to mammography, detects additional cancers in women with dense breasts. However, labor intensity, operator dependence and high recall rates have limited adoption. This paper describes the use of ultrasound tomography for whole-breast tissue stiffness measurements as a first step toward addressing the issue of high recall rates. The validation of the technique using an anthropomorphic phantom is described. In-vivo applications are demonstrated on 13 breast masses, indicating that lesion stiffness correlates with lesion type as expected. Comparison of lesion stiffness measurements with standard elastography was available for 11 masses and showed a strong correlation between the 2 measures. It is concluded that ultrasound tomography can map out the 3 dimensional distribution of tissue stiffness over the whole breast. Such a capability is well suited for screening where additional characterization may improve the specificity of screening ultrasound, thereby lowering barriers to acceptance.
Ultrasound tomography (UST) employs sound waves to produce three-dimensional images of breast tissue and precisely measures the attenuation of sound speed secondary to breast tissue composition. High breast density is a strong breast cancer risk factor and sound speed is directly proportional to breast density. UST provides a quantitative measure of breast density based on three-dimensional imaging without compression, thereby overcoming the shortcomings of many other imaging modalities. The quantitative nature of the UST breast density measures are tied to an external standard, so sound speed measurement in breast tissue should be independent of specific hardware. The work presented here compares breast sound speed measurement obtained with two different UST devices. The Computerized Ultrasound Risk Evaluation (CURE) system located at the Karmanos Cancer Institute in Detroit, Michigan was recently replaced with the SoftVue ultrasound tomographic device. Ongoing clinical trials have used images generated from both sets of hardware, so maintaining consistency in sound speed measurements is important. During an overlap period when both systems were in the same exam room, a total of 12 patients had one or both of their breasts imaged on both systems on the same day. There were 22 sound speed scans analyzed from each system and the average breast sound speeds were compared. Images were either reconstructed using saved raw data (for both CURE and SoftVue) or were created during the image acquisition (saved in DICOM format for SoftVue scans only). The sound speed measurements from each system were strongly and positively correlated with each other. The average difference in sound speed between the two sets of data was on the order of 1-2 m/s and this result was not statistically significant. The only sets of images that showed a statistical difference were the DICOM images created during the SoftVue scan compared to the SoftVue images reconstructed from the raw data. However, the discrepancy between the sound speed values could be easily handled by uniformly increasing the DICOM sound speed by approximately 0.5 m/s. These results suggest that there is no fundamental difference in sound speed measurement for the two systems and support combining data generated with these instruments in future studies.
We describe the clinical performance of SoftVue, a breast imaging device based on the principles of ultrasound tomography. Participants were enrolled in an IRB-approved study at Wayne State University, Detroit, MI. The main research findings indicate that SoftVue is able to image the whole uncompressed breast up to cup size H. Masses can be imaged in even the densest breasts with the ability to discern margins and mass shapes. Additionally, it is demonstrated that multi-focal disease can also be imaged. The system was also tested in its research mode for additional imaging capabilities. These tests demonstrated the potential for generating tissue stiffness information for the entire breast using through-transmission data. This research capability differentiates SoftVue from the other whole breast systems on the market. It is also shown that MRI-like images can be generated using alternative processing of the echo data. Ongoing research is focused on validating and quantifying these findings in a larger sample of study participants and quantifying SoftVue's ability to differentiate benign masses from cancer.
For women with dense breast tissue, who are at much higher risk for developing breast cancer, the performance of mammography is at its worst. Consequently, many early cancers go undetected when they are the most treatable. Improved cancer detection for women with dense breasts would decrease the proportion of breast cancers diagnosed at later stages, which would significantly lower the mortality rate. The emergence of whole breast ultrasound provides good performance for women with dense breast tissue, and may eliminate the current trade-off between the cost effectiveness of mammography and the imaging performance of more expensive systems such as magnetic resonance imaging. We report on the performance of SoftVue, a whole breast ultrasound imaging system, based on the principles of ultrasound tomography. SoftVue was developed by Delphinus Medical Technologies and builds on an early prototype developed at the Karmanos Cancer Institute. We present results from preliminary testing of the SoftVue system, performed both in the lab and in the clinic. These tests aimed to validate the expected improvements in image performance. Initial qualitative analyses showed major improvements in image quality, thereby validating the new imaging system design. Specifically, SoftVue’s imaging performance was consistent across all breast density categories and had much better resolution and contrast. The implications of these results for clinical breast imaging are discussed and future work is described.
Women with high breast density have an increased risk of developing breast cancer. Women treated with the selective estrogen receptor modulator tamoxifen for estrogen receptor positive breast cancer experience a 50% reduction in risk of contralateral breast cancer and overall reduction of similar magnitude has been identified among high-risk women receiving the drug for prevention. Tamoxifen has been shown to reduce mammographic density, and in the IBIS-1 chemoprevention trial, risk reduction and decline in density were significantly associated. Ultrasound tomography (UST) is an imaging modality that can create tomographic sound speed images of the breast. These sound speed images are useful because breast density is proportional to sound speed. The aim of this work is to examine the relationship between USTmeasured breast density and the use of tamoxifen. So far, preliminary results for a small number of patients have been observed and are promising. Correlations between the UST-measured density and
mammographic density are strong and positive, while relationships between UST density with some patient specific risk factors behave as expected. Initial results of UST examinations of tamoxifen treated patients show that approximately 45% of the patients have a decrease in density in the contralateral breast after only several months of treatment. The true effect of tamoxifen on UST-measured density cannot yet be fully determined until more data are collected. However, these promising results suggest that UST can be used to reliably assess quantitative changes in breast density over short intervals and therefore suggest that UST may enable rapid assessment of density changes associated with therapeutic and preventative interventions.
It is known that breast cancer risk is greater in women with higher breast densities. Currently, breast
density is measured using mammographic percent density, defined as the ratio of fibroglandular to total
breast area on a two dimensional mammogram. Alternatively, systems that use ultrasound tomography
(UST) create tomographic sound speed images of the patient's breast. These volumetric images can be
useful as a diagnostic aid because it is also known that sound speed of tissue is proportional to the density
of the tissue. The purpose of this work is to expand on the comparisons of the two imaging modalities by
introducing new ultrasound tomography measurements that separate and quantify the fatty and dense tissue
distributions within the breast. A total of 249 patients were imaged using both imaging modalities. By
using k-means clustering, correlations beyond the volume averaged sound speed of the ultrasound images
and the mammographic percent density were investigated. Both the ultrasound and mammographic images
were separated into dense and fatty regions. Various associations between the global breast properties as
well as separate tissue components were found.
Conventional sonography, which performs well in dense breast tissue and is comfortable and radiation-free, is
not practical for screening because of its operator dependence and the time needed to scan the whole breast.
While magnetic resonance imaging (MRI) can significantly improve on these limitations, it is also not
practical because it has long been prohibitively expensive for routine use. There is therefore a need for an
alternative breast imaging method that obviates the constraints of these standard imaging modalities. The
lack of such an alternative is a barrier to dramatically impacting mortality (about 45,000 women in the US per
year) and morbidity from breast cancer because, currently, there is a trade-off between the cost effectiveness
of mammography and sonography on the one hand and the imaging accuracy of MRI on the other. This paper
presents a progress report on our long term goal to eliminate this trade-off and thereby improve breast cancer
survival rates and decrease unnecessary biopsies through the introduction of safe, cost-effective, operatorindependent
sonography that can rival MRI in accuracy.
The objective of the study described in this paper was to design and build an improved ultrasound
tomography (UST) scanner in support of our goals. To that end, we report on a design that builds on our
current research prototype. The design of the new scanner is based on a comparison of the capabilities of our
existing prototype and the performance needed for clinical efficacy. The performance gap was quantified by
using clinical studies to establish the baseline performance of the research prototype, and using known MRI
capabilities to establish the required performance. Simulation software was used to determine the basic
operating characteristics of an improved scanner that would provide the necessary performance. Design
elements focused on transducer geometry, which in turn drove the data acquisition system and the image
reconstruction engine specifications. The feasibility of UST established by our earlier work and that of other
groups, forms the rationale for developing a UST system that has the potential to become a practical, low-cost
device for breast cancer screening and diagnosis.
The objective of this study is to present imaging parameters and display thresholds of an ultrasound tomography (UST)
prototype in order to demonstrate analogous visualization of overall breast anatomy and lesions relative to magnetic
resonance (MR). Thirty-six women were imaged with MR and our UST prototype. The UST scan generated sound
speed, attenuation, and reflection images and were subjected to variable thresholds then fused together into a single UST
image. Qualitative and quantitative comparisons of MR and UST images were utilized to identify anatomical similarities
and mass characteristics. Overall, UST demonstrated the ability to visualize and characterize breast tissues in a manner
comparable to MR without the use of IV contrast. For optimal visualization, fused images utilized thresholds of 1.46±0.1
km/s for sound speed to represent architectural features of the breast including parenchyma. An arithmetic combination
of images using the logical .AND. and .OR. operators, along with thresholds of 1.52±0.03 km/s for sound speed and
0.16±0.04 dB/cm for attenuation, allowed for mass detection and characterization similar to MR.
Despite some shortcomings, mammography is currently the standard of care for breast cancer screening and
diagnosis. However, breast ultrasound tomography is a rapidly developing imaging modality that has the
potential to overcome the drawbacks of mammography. It is known that women with high breast densities
have a greater risk of developing breast cancer. Measuring breast density is accomplished through the use
of mammographic percent density, defined as the ratio of fibroglandular to total breast area. Using an
ultrasound tomography (UST) prototype, we created sound speed images of the patient's breast, motivated
by the fact that sound speed in a tissue is proportional to the density of the tissue. The purpose of this work
is to compare the acoustic performance of the UST system with the measurement of mammographic
percent density. A cohort of 251 patients was studied using both imaging modalities and the results suggest
that the volume averaged breast sound speed is significantly related to mammographic percent density.
The Spearman correlation coefficient was found to be 0.73 for the 175 film mammograms and 0.69 for the
76 digital mammograms obtained. Since sound speed measurements do not require ionizing radiation or
physical compression, they have the potential to form the basis of a safe, more accurate surrogate marker of
breast density.
We report on the use of ultrasound tomography (UST) to characterize breast cancer and study the local and
distant tumor environments. We have imaged the tumor and its environment in 3 cases of breast cancer using
a UST prototype and its associated image reconstruction algorithms. After generating images of reflection,
sound speed and attenuation, the images were fused in combinations that allowed visualization and
characterization of the interior of the tumor as well as the tissue immediate to the tumor and beyond. The
reflection UST images demonstrated the presence of spiculation, and architectural distortion, indicators of
both local tumor invasion and distant involvement with surrounding tissues. Furthermore, the sound speed
images showed halos of elevated sound speed surrounding the tumors, indicating a local environment
characterized by stiff tissues. The combination of sound speed and attenuation images revealed that the
tumor interiors were the stiffest tissues in the region studied. These features and characteristics are
commensurate with the known biomechanical properties of cancer and may be manifestations of the
desmoplastic process that is associated with tumor invasion. We propose that UST imaging may prove to be a
valuable tool for characterizing cancers and studying the tumor invasion process.
The purpose of this study was to investigate the performance of an ultrasound tomography (UST) prototype relative to
magnetic resonance (MR) for imaging overall breast anatomy and accentuating tumors relative to background tissue.
The study was HIPAA compliant, approved by the Institutional Review Board, and performed after obtaining the
requisite informed consent. Twenty-three patients were imaged with MR and the UST prototype. T1 weighted images
with fat saturation, with and without gadolinium enhancement, were used to examine anatomical structures and tumors,
while T2 weighted images were used to identify cysts. The UST scans generated sound speed, attenuation, and reflection
images. A qualitative visual comparison of the MRI and UST images was then used to identify anatomical similarities. A
more focused approach that involved a comparison of reported masses, lesion volumes, and breast density was used to
quantify the findings from the visual assessment. Our acoustic tomography prototype imaged distributions of fibrous
stroma, parenchyma, fatty tissues, and lesions in patterns similar to those seen in the MR images. The range of
thresholds required to establish tumor volume equivalency between MRI and UST suggested that a universal threshold for isolating masses relative to background tissue is feasible with UST. UST has demonstrated the ability to visualize and characterize breast tissues in a manner comparable to MRI. Thresholding techniques accentuate masses relative to background anatomy, which may prove clinically useful for early cancer detection.
The purpose of this study was to correlate changes in biomechanical properties of breast cancer lesions in response to
neoadjuvant chemotherapy. Nine patients were examined repeatedly throughout their treatment, using an experimental
prototype based on the principles of ultrasound tomography. The study was HIPAA compliant, approved by the
Institutional Review Board, and performed after obtaining the requisite informed consent. Images of reflection, sound
speed and attenuation, representing the entire volume of the breast, were reconstructed from the exam data and analyzed
for time-dependent changes during the treatment period. It was found that changes in tumor properties could be
measured in all cases. Furthermore, changes in sound speed were found to vary strongly from patient to patient. A
comparison of the sound speed response curves with pathological findings suggests that complete responders exhibit
distinctly different responses as measured by sound speed. These preliminary results were used to define a cut-point for
predicting response. Subsequently, a prospective prediction of the treatment response of a new patient was made
correctly. We hypothesize that changes in the biomechanical properties of breast cancers, as measured by sound speed,
can predict response. Future studies will focus on testing this hypothesis and defining and quantifying markers of response.
Since a 1976 study by Wolfe, high breast density has gained recognition as a factor strongly correlating with an
increased incidence of breast cancer. These observations have led to mammographic density being designated a "risk
factor" for breast cancer. Clinically, the exclusive reliance on mammography for breast density measurement has
forestalled the inclusion of breast density into statistical risk models. This exclusion has in large part been due to the
ionizing radiation associated with the method. Additionally, the use of mammography as valid tool for measuring a three
dimensional characteristic (breast density) has been criticized for its prima facie incongruity. These shortfalls have
prompted MRI studies of breast density as an alternative three-dimensional method of assessing breast density.
Although, MRI is safe and can be used to measure volumetric density, its cost has prohibited its use in screening. Here,
we report that sound speed measurements using a prototype ultrasound tomography device have potential for use as surrogates for breast density measurement. Accordingly, we report a strong positive linear correlation between volume-averaged sound speed of the breast and percent glandular tissue volume as assessed by MR.
Our laboratory has focused on the development of ultrasound tomography (UST) for breast imaging. To that end we
have been developing and testing a clinical prototype in the Karmanos Cancer Institute's (KCI) breast center. The
development of our prototype has been guided by clinical feedback from data accumulated from over 300 patients
recruited over the last 4 years. Our techniques generate whole breast reflection images as well as images of the acoustic
parameters of sound speed and attenuation. The combination of these images reveals major breast anatomy, including
fat, parenchyma, fibrous stroma and masses. Fusion imaging, utilizing thresholding, is shown to visualize mass
characterization and facilitates separation of cancer from benign masses. These results indicate that operator-independent
whole-breast imaging and the detection and characterization of cancerous breast masses are feasible using acoustic
tomography techniques.
Analyses of the prototype images suggests that we can detect the variety of mass attributes noted by current ultrasound-BIRADS criteria, such as mass shape, acoustic mass properties and architecture of the tumor environment. These
attributes help quantify current BIRADS criteria (e.g. "shadowing" or high attenuation) and provide greater possibilities
for defining a unique signature of cancer. The potential for UST to detect and characterize breast masses was quantified
using UST measurements of 86 masses from the most recent cohort of patients imaged with the latest version of our prototype. Our preliminary results suggest that the development of a formal predictive model, in support of larger future trials, is warranted.
The objective of this study is to investigate a potential low-cost-alternative to MRI, based on acoustic tomography.
Using MRI as the gold standard, our goals are to assess the performance of acoustic tomography in (i) depicting normal
breast anatomy, (ii) imaging cancerous lesions and (iii) accentuating lesions relative to background tissue using
thresholding techniques. Fifteen patients were imaged with MRI and with an acoustic tomography prototype. A
qualitative visual comparison of the MRI and prototype images was used to verify anatomical similarities. These
similarities suggest that the prototype can image fibrous stroma, parenchyma and fatty tissues, with similar sensitivity to
MRI. The prototype was also shown to be able to image masses but equivalency in mass sensitivity with MRI could not
be established because of the small numbers of patients and the prototype's limited scanning range. The range of
thresholds required to establish tumor volume equivalency suggests that a universal threshold for isolating masses
relative to background tissue is possible with acoustic tomography. Thresholding techniques promise to accentuate
masses relative to background anatomy which may prove clinically useful in potential screening applications. Future
work will utilize larger trials to verify these preliminary conclusions.
We report on a continuing assessment of the in-vivo performance of an operator independent breast imaging device
based on the principles of acoustic tomography. This study highlights the feasibility of mass characterization using
criteria derived from reflection, sound speed and attenuation imaging. The data were collected with a clinical prototype
at the Karmanos Cancer Institute in Detroit MI from patients recruited at our breast center. Tomographic sets of images
were constructed from the data and used to form 3-D image stacks corresponding to the volume of the breast. Masses
were identified independently by either ultrasound or biopsy and their locations determined from conventional
mammography and ultrasound exams. The nature of the mass and its location were used to assess the feasibility of our
prototype to detect and characterize masses in a case-following scenario.
Our techniques generated whole breast reflection images as well as images of the acoustic parameters of sound speed
and attenuation. The combination of these images reveals major breast anatomy, including fat, parenchyma, fibrous
stroma and masses. The three types of images are intrinsically co-registered because the reconstructions are performed
using a common data set acquired by the prototype. Fusion imaging, utilizing thresholding, is shown to visualize mass
characterization and facilitates separation of cancer from benign masses. These initial results indicate that operatorindependent
whole-breast imaging and the detection and a characterization of cancerous breast masses are feasible using
acoustic tomography techniques.
As part of an ongoing assessment of the in-vivo performance of a operator independent breast imaging device, based on
acoustic tomography, we report on new results obtained with patients undergoing neoadjuvant chemotherapy. Five
patients were examined with the prototype on multiple occasions corresponding in time to their chemotherapy sessions.
Images of reflection, sound speed and attenuation, representing the entire volume of the breast, were reconstructed from
the exam data and analyzed for time-dependent changes during the treatment period. It was found that changes in
acoustic properties of the tumors could be measured directly from the images. The measured properties include
reflectivity, sound speed and attenuation, leading to measurable changes in the volume, shape and internal attributes of
the tumors. These measurements were used to monitor the response of the tumors to the therapy with the long term goal
of correlating results with pathological and clinical outcomes. Comparisons with tumor size changes based on traditional
US and MRI indicates potential for accurate, quantifiable tracking of tumor volume. Furthermore, our tentative results
also show declines in internal properties of the tumors, possibly relating to a reduction in tissue stiffness and/or density.
Future work will include an expansion of the study to a larger cohort of patients for determining the statistical
significance of our findings.
A major limitation of thermal therapies is the lack of detailed thermal information needed to monitor the
therapy. Temperatures are routinely measured invasively with thermocouples, but only sparse measurements
can be made. Ultrasound tomography is an attractive modality for temperature monitoring because it is noninvasive,
non-ionizing, convenient and inexpensive. It capitalizes on the fact that the changes in temperature
cause the changes in sound speed. In this work we investigate the possibility of monitoring large temperature
changes, in the interval from body temperature to -40°C. The ability to estimate temperature in this interval is
of a great importance in cryosurgery, where freezing is used to destroy abnormal tissue. In our experiment, we
freeze locally a tissue-mimicking phantom using a combination of one, two or three cryoprobes. The estimation of
sound speed is a difficult task because, first, the sound is highly attenuated when traversing the frozen tissue; and
second, the sound speed to be reconstructed has a high spatial bandwidth, due to the dramatic change in speed
between the frozen and unfrozen tissue. We show that the first problem can be overcome using a beamforming
technique. As the classical reconstruction algorithms inherently smooth the reconstruction, we propose to solve
the second problem by applying reconstruction techniques based on sparsity.
We report and discuss clinical breast imaging results obtained with operator independent ultrasound tomography. A
series of breast exams are carried out using a recently upgraded clinical prototype designed and built on the principles of
ultrasound tomography. The in-vivo performance of the prototype is assessed by imaging patients at the Karmanos
Cancer Institute. Our techniques successfully demonstrate in-vivo tomographic imaging of breast architecture in both
reflection and transmission imaging modes. These initial results indicate that operator-independent whole-breast imaging
and the detection of cancerous breast masses are feasible using ultrasound tomography techniques. This approach has
the potential to provide a low cost, non-invasive, and non-ionizing means of evaluating breast masses. Future work will
concentrate on extending these results to larger trials.
Women with high mammographic breast density are at 4- to 6-fold increased risk of developing breast cancer compared
to women with fatty breasts. However, current breast density estimations rely on mammography, which cannot provide
accurate volumetric breast representation. Therefore, we explored two techniques of breast density evaluation via
ultrasound tomography. A sample of 93 patients was imaged with our clinical prototype; each dataset contained 45-75
tomograms ranging from near the chest wall through the nipple. Whole breast acoustic velocity was determined by
creating image stacks and evaluating the sound speed frequency distribution. Ultrasound percent density (USPD) was
determined by segmenting high sound speed areas from each tomogram using k-means clustering, integrating over the
entire breast, and dividing by total breast area. Both techniques were independently evaluated using two mammographic
density measures: (1) qualitative, determined by a radiologist's visual assessment using BI-RADS Categories, and (2)
quantitative, via semi-automatic segmentation to calculate mammographic percent density (MPD) for craniocaudal and
medio-lateral oblique mammograms. ~140 m/s difference in acoustic velocity was observed between fatty and dense BI-RADS
Categories. Increased sound speed was found with increased BI-RADS Category and quantitative MPD.
Furthermore, strong positive associations between USPD, BI-RADS Category, and calculated MPD were observed.
These results confirm that utilizing sound speed, both for whole-breast evaluation and segmenting locally, can be
implemented to evaluate breast density.
Waveform tomography results are presented from 800 kHz ultrasound transmission scans of a breast phantom, and from an in vivo ultrasound breast scan: significant improvements are demonstrated in resolution over time-of-flight reconstructions. Quantitative reconstructions of both sound-speed and inelastic attenuation are recovered. The data were acquired in the Computed Ultrasound Risk Evaluation (CURE) system, comprising a 20 cm diameter solid-state ultrasound ring array with 256 active, non-beamforming transducers.
Waveform tomography is capable of resolving variations in acoustic properties at sub-wavelength scales. This was verified through comparison of the breast phantom reconstructions with x-ray CT results: the final images resolve variations in sound speed with a spatial resolution close to 2 mm.
Waveform tomography overcomes the resolution limit of time-of-flight methods caused by finite frequency (diffraction) effects. The method is a combination of time-of-flight tomography, and 2-D acoustic waveform inversion of the transmission arrivals in ultrasonic data. For selected frequency components of the waveforms, a finite-difference simulation of the visco-acoustic wave equation is used to compute synthetic data in the current model, and the data residuals are formed by subtraction. The residuals are used in an iterative, gradient-based scheme to update the sound-speed and attenuation model to produce a reduced misfit to the data. Computational efficiency is achieved through the use of time-reversal of the data residuals to construct the model updates. Lower frequencies are used first, to establish the long wavelength components of the image, and higher frequencies are introduced later to provide increased resolution.
Ultrasonic imaging has the potential to enhance our capability to detect and diagnose breast cancers, but its imaging quality and resolution need to be significantly improved. We make use of the principle of the time-reversal mirror to develop an image-reconstruction method for ultrasonic breast imaging. It reconstructs images of scatterers (e.g., tumors) that generate/scatter ultrasonic waves by backpropagating measured ultrasonic signals into a heterogeneous breast model on computers using the principle of time-reversal mirror. We use solutions of the (two-way) full wave equation and one-way wave equation in heterogeneous media for backpropagation. We found that the one-way wave-equation-based imaging method can produce higher-resolution images than the two-way propagation-based imaging method when the data acquisition aperture is limited (for a linear transducer array). With a full aperture, our imaging results demonstrate that imaging with time-reversed ultrasound can produce high-quality images of the breast.
Reflection imaging has the potential to produce higher-resolution breast images than transmission tomography; however, the current clinical reflection imaging technique yields poor-quality breast images due to speckle. We present a new ultrasonic breast imaging method for obtaining high-resolution and clear breast images using ultrasonic reflection data acquired by a new ultrasonic scanning device that provides a better illumination of targets of interest than the clinical B-scan. The new imaging method is based on the solution of the wave equation in Cartesian coordinates and is implemented using Fast Fourier Transform algorithms. We apply the new ultrasonic breast imaging method to two ultrasonic data sets obtained using an experimental ultrasound scanner recently developed by the Karmanos Cancer Institute. One data set was acquired for a "cyst" phantom using 360 transmitter positions and 321 receiver positions along a 20-cm diameter ring. Another data set was collected with 180 transmitter positions and 1601 receiver positions along a 30-cm diameter ring with the breast specimen located at the center of the ring. We report on the breast imaging results for these two data sets using the new breast imaging method. The results demonstrate that the wave-equation-based ultrasonic breast imaging has the potential to produce high-resolution breast images.
The Karmanos Cancer Institute is developing an ultrasound device for measuring and imaging acoustic parameters of human tissue. This paper discusses the experimental results relating to tomographic reconstructions of phantoms and tissue. The specimens were scanned by the prototype scanner at a frequency of 1.5 MHz using 2 microsecond pulses. The receivers and transmitters were positioned along a ring trajectory having a diameter of 20 cm. The ring plane is translated in the vertical direction allowing for 3-D reconstructions from stacked 2-D planes of data. All ultrasound scans were performed at 10 millimeter slice thickness to generate multiple tomographic images. In a previous SPIE paper we presented preliminary results of ultrasound tomographic reconstruction of formalin-fixed breast tissue. We now present new results from data acquired with the scanner. Images were constructed using both reflection-based and transmission based algorithms. The resulting images demonstrate the ability to detect sub-mm features and to measure acoustic properties such as sound speed. Comparison with conventional ultrasound indicates the potential for better margin definition and acoustic characterization of tissue.
New ultrasound data, obtained with a circular experimental scanner, are compared with data obtained with standard X-ray CT. Ultrasound data obtained by scanning fixed breast tissue were used to generate images of sound speed and reflectivity. The ultrasound images exhibit approximately 1 mm resolution and about 20 dB of dynamic range. All data were obtained in a circular geometry. X-ray CT scans were used to generate X-ray images corresponding to the same 'slices' obtained with the ultrasound scanner. The good match of sensitivity, resolution and angular coverage between the ultrasound and X-ray data makes possible a direct comparison of the three types of images. We present the results of such a comparison for an excised breast fixed in formalin. The results are presented visually using various types of data fusion. A general correspondence between the sound speed, reflectivity and X-ray morphologies is found. The degree to which data fusion can help characterize tissue is assessed by examining the quantitative correlations between the ultrasound and X-ray images.
Extremely high quality data was acquired using an experimental ultrasound scanner developed at Lawrence Livermore National Laboratory using a 2D ring geometry with up to 720 transmitter/receiver transducer positions. This unique geometry allows reflection and transmission modes and transmission imaging and quantification of a 3D volume using 2D slice data. Standard image reconstruction methods were applied to the data including straight-ray filtered back projection, reflection tomography, and diffraction tomography. Newer approaches were also tested such as full wave, full wave adjoint method, bent-ray filtered backprojection, and full-aperture tomography. A variety of data sets were collected including a formalin-fixed human breast tissue sample, a commercial ultrasound complex breast phantom, and cylindrical objects with and without inclusions. The resulting reconstruction quality of the images ranges from poor to excellent. The method and results of this study are described including like-data reconstructions produced by different algorithms with side-by-side image comparisons. Comparisons to medical B-scan and x-ray CT scan images are also shown. Reconstruction methods with respect to image quality using resolution, noise, and quantitative accuracy, and computational efficiency metrics will also be discussed.
In contrast to standard reflection ultrasound (US), transmission US holds the promise of more thorough tissue characterization by generating quantitative acoustic parameters. We compare results from a conventional US scanner with data acquired using an experimental circular scanner operating at frequencies of 0.3 - 1.5 MHz. Data were obtained on phantoms and a normal, formalin-fixed, excised breast. Both reflection and transmission-based algorithms were used to generate images of reflectivity, sound speed and attenuation.. Images of the phantoms demonstrate the ability to detect sub-mm features and quantify acoustic properties such as sound speed and attenuation. The human breast specimen showed full field evaluation, improved penetration and tissue definition. Comparison with conventional US indicates the potential for better margin definition and acoustic characterization of masses, particularly in the complex scattering environments of human breast tissue. The use of morphology, in the context of reflectivity, sound speed and attenuation, for characterizing tissue, is discussed.
Tomographic images of tissue phantoms and a sample of breast tissue have been produced from an acoustic synthetic array system for frequencies near 500 kHz. The images for sound speed and attenuation show millimeter resolution and demonstrate the feasibility of obtaining high-resolution tomographic images with frequencies that can deeply penetrate tissue. The image reconstruction method is based on the Born approximation to acoustic scattering and is a simplified version of a method previously used by Andre (Andre, et. al., Int. J. Imaging Systems and Technology, Vol 8, No. 1, 1997) for a circular acoustic array system. The images have comparable resolution to conventional ultrasound images at much higher frequencies (3-5 MHz) but with lower speckle noise. This shows the potential of low frequency, deeply penetrating, ultrasound for high-resolution quantitative imaging.
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