Results for “ULTRASOUND” — Page 2

DOE OSTI2015

MO-AB-210-01: Ultrasound Imaging and Therapy-Hands On Workshop

The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrations with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant 5R25NS080949 and Philips Healthcare research grant C32.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-AB-210-02: Ultrasound Imaging and Therapy-Hands On Workshop

The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrations with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant 5R25NS080949 and Philips Healthcare research grant C32.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-AB-210-03: Workshop [ Advancements in high intensity focused ultrasound ]

The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrations with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant 5R25NS080949 and Philips Healthcare research grant C32.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

WE-B-210-02: The Advent of Ultrafast Imaging in Biomedical Ultrasound

In the last fifteen years, the introduction of plane or diverging wave transmissions rather than line by line scanning focused beams has broken the conventional barriers of ultrasound imaging. By using such large field of view transmissions, the frame rate reaches the theoretical limit of physics dictated by the ultrasound speed and an ultrasonic map can be provided typically in tens of micro-seconds (several thousands of frames per second). Interestingly, this leap in frame rate is not only a technological breakthrough but it permits the advent of completely new ultrasound imaging modes, including shear wave elastography, electromechanical wave imaging, ultrafast doppler, ultrafast contrast imaging, and even functional ultrasound imaging of brain activity (fUltrasound) introducing Ultrasound as an emerging full-fledged neuroimaging modality. At ultrafast frame rates, it becomes possible to track in real time the transient vibrations – known as shear waves – propagating through organs. Such “human body seismology” provides quantitative maps of local tissue stiffness whose added value for diagnosis has been recently demonstrated in many fields of radiology (breast, prostate and liver cancer, cardiovascular imaging, …). Today, Supersonic Imagine company is commercializing the first clinical ultrafast ultrasound scanner, Aixplorer with real time Shear Wave Elastography. This is the first example of an ultrafast Ultrasound approach surpassing the research phase and now widely spread in the clinical medical ultrasound community with an installed base of more than 1000 Aixplorer systems in 54 countries worldwide. For blood flow imaging, ultrafast Doppler permits high-precision characterization of complex vascular and cardiac flows. It also gives ultrasound the ability to detect very subtle blood flow in very small vessels. In the brain, such ultrasensitive Doppler paves the way for fUltrasound (functional ultrasound imaging) of brain activity with unprecedented spatial and temporal resolution compared to fMRI. Combined with contrast agents, our group demonstrated that Ultrafast Ultrasound Localization could provide a first in vivo and non invasive imaging modality at microscopic scales deep into organs. Many of these ultrafast modes should lead to major improvements in ultrasound screening, diagnosis, and therapeutic monitoring. Learning Objectives: Achieve familiarity with recent advances in ultrafast ultrasound imaging technology. Develop an understanding of potential applications of ultrafast ultrasound imaging for diagnosis and therapeutic monitoring. Dr. Tanter is a co-founder of Supersonic Imagine,a French company positioned in the field of medical ultrasound imaging and therapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

WE-AB-206-01: Diagnostic Ultrasound Imaging Quality Assurance

The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. The goal of this ultrasound hands-on workshop is to demonstrate quality control (QC) testing in diagnostic ultrasound and to provide updates in ACR ultrasound accreditation requirements. The first half of this workshop will include two presentations reviewing diagnostic ultrasound QA/QC and ACR ultrasound accreditation requirements. The second half of the workshop will include live demonstrations of basic QC tests. An array of ultrasound testing phantoms and ultrasound scanners will be available for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations and on-site instructors. The targeted attendees are medical physicists in diagnostic imaging. Learning Objectives: Gain familiarity with common elements of a QA/QC program for diagnostic ultrasound imaging dentify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools Learn ACR ultrasound accreditation requirements Jennifer Walter is an employee of American College of Radiology on Ultrasound Accreditation.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2016

WE-AB-206-02: ACR Ultrasound Accreditation: Requirements and Pitfalls

The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. The goal of this ultrasound hands-on workshop is to demonstrate quality control (QC) testing in diagnostic ultrasound and to provide updates in ACR ultrasound accreditation requirements. The first half of this workshop will include two presentations reviewing diagnostic ultrasound QA/QC and ACR ultrasound accreditation requirements. The second half of the workshop will include live demonstrations of basic QC tests. An array of ultrasound testing phantoms and ultrasound scanners will be available for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations and on-site instructors. The targeted attendees are medical physicists in diagnostic imaging. Learning Objectives: Gain familiarity with common elements of a QA/QC program for diagnostic ultrasound imaging dentify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools Learn ACR ultrasound accreditation requirements Jennifer Walter is an employee of American College of Radiology on Ultrasound Accreditation.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2014

SU-E-J-118: Verification of Intrafractional Positional Accuracy Using Ultrasound Autoscan Tracking for Prostate Cancer Treatment

Purpose: Transperineal ultrasound imaging is attractive option for imageguided radiation therapy as there is no need to implant fiducials, no extra imaging dose, and real time continuous imaging is possible during treatment. The aim of this study is to verify the tracking accuracy of a commercial ultrasound system under treatment conditions with a male pelvic phantom. Methods: A CT and ultrasound scan were acquired for the male pelvic phantom. The phantom was then placed in a treatment mimicking position on a motion platform. The axial and lateral tracking accuracy of the ultrasound system were verified using an independent optical tracking system. The tracking accuracy was evaluated by tracking the phantom position detected by the ultrasound system, and comparing it to the optical tracking system under the conditions of beam on (15 MV), beam off, poor image quality with an acoustic shadow introduced, and different phantom motion cycles (10 and 20 second periods). Additionally, the time lag between the ultrasound-detected and actual phantom motion was investigated. Results: Displacement amplitudes reported by the ultrasound system and optical system were within 0.5 mm of each other for both directions and all conditions. The ultrasound tracking performance in axial direction was better than in lateral direction. Radiation did not interfere with ultrasound tracking while image quality affected tracking accuracy. The tracking accuracy was better for periodic motion with 20 second period. The time delay between the ultrasound tracking system and the phantom motion was clinically acceptable. Conclusion: Intrafractional prostate motion is a potential source of treatment error especially in the context of emerging SBRT regimens. It is feasible to use transperineal ultrasound daily to monitor prostate motion during treatment. Our results verify the tracking accuracy of a commercial ultrasound system to be better than 1 mm under typical external beam treatment conditions.

60 APPLIED LIFE SCIENCES↗

NASA NTRS2010

Interference-free ultrasound imaging during HIFU therapy, using software tools

Disclosed herein is a method for obtaining a composite interference-free ultrasound image when non-imaging ultrasound waves would otherwise interfere with ultrasound imaging. A conventional ultrasound imaging system is used to collect frames of ultrasound image data in the presence of non-imaging ultrasound waves, such as high-intensity focused ultrasound (HIFU). The frames are directed to a processor that analyzes the frames to identify portions of the frame that are interference-free. Interference-free portions of a plurality of different ultrasound image frames are combined to generate a single composite interference-free ultrasound image that is displayed to a user. In this approach, a frequency of the non-imaging ultrasound waves is offset relative to a frequency of the ultrasound imaging waves, such that the interference introduced by the non-imaging ultrasound waves appears in a different portion of the frames.

Vaezy, Shahram↗

DOE OSTI2015

WE-A-210-00: Educational: Diagnostic Ultrasound QA

This presentation will focus on the present role of ultrasound medical physics in clinical practices. The first part of the presentation will provide an overview of ultrasound QC methodologies and testing procedures. A brief review of ultrasound phantoms utilized in these testing procedures will be presented. The second part of the presentation will summarize ultrasound imaging technical standards and professional guidelines by American College of Radiology (ACR), American Institute of Ultrasound in Medicine (AIUM), American Association of Physicists in Medicine (AAPM) and International Electrotechnical Commission (IEC). The current accreditation requirements by ACR and AIUM for ultrasound practices will be described and the practical aspects of implementing QC programs to be compliant with these requirements will be discussed. Learning Objectives: Achieve familiarity with common ultrasound QC test methods and ultrasound phantoms. Understand the coverage of the existing testing standards and professional guidelines on diagnostic ultrasound imaging. Learn what a medical physicist needs to know about ultrasound program accreditation and be able to implement ultrasound QC programs accordingly.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

MO-FG-CAMPUS-JeP3-04: Feasibility Study of Real-Time Ultrasound Monitoring for Abdominal Stereotactic Body Radiation Therapy

Purpose: Ultrasound is ideal for real-time monitoring in radiotherapy with high soft tissue contrast, non-ionization, portability, and cost effectiveness. Few studies investigated clinical application of real-time ultrasound monitoring for abdominal stereotactic body radiation therapy (SBRT). This study aims to demonstrate the feasibility of real-time monitoring of 3D target motion using 4D ultrasound. Methods: An ultrasound probe holding system was designed to allow clinician to freely move and lock ultrasound probe. For phantom study, an abdominal ultrasound phantom was secured on a 2D programmable respiratory motion stage. One side of the stage was elevated than another side to generate 3D motion. The motion stage made periodic breath-hold movement. Phantom movement tracked by infrared camera was considered as ground truth. For volunteer study three healthy subjects underwent the same setup for abdominal SBRT with active breath control (ABC). 4D ultrasound B-mode images were acquired for both phantom and volunteers for real-time monitoring. 10 breath-hold cycles were monitored for each experiment. For phantom, the target motion tracked by ultrasound was compared with motion tracked by infrared camera. For healthy volunteers, the reproducibility of ABC breath-hold was evaluated. Results: Volunteer study showed the ultrasound system fitted well to the clinical SBRT setup. The reproducibility for 10 breath-holds is less than 2 mm in three directions for all three volunteers. For phantom study the motion between inspiration and expiration captured by camera (ground truth) is 2.35±0.02 mm, 1.28±0.04 mm, 8.85±0.03 mm in LR, AP, SI directly, respectively. The motion monitored by ultrasound is 2.21±0.07 mm, 1.32±0.12mm, 9.10±0.08mm, respectively. The motion monitoring error in any direction is less than 0.5 mm. Conclusion: The volunteer study proved the clinical feasibility of real-time ultrasound monitoring for abdominal SBRT. The phantom and volunteer ABC studies demonstrated sub-millimeter accuracy of 3D motion movement monitoring.

60 APPLIED LIFE SCIENCES↗

NASA NTRS2005

Ocular examination for trauma; clinical ultrasound aboard the International Space Station

BACKGROUND: Ultrasound imaging is a successful modality in a broad variety of diagnostic applications including trauma. Ultrasound has been shown to be accurate when performed by non-radiologist physicians; recent reports have suggested that non-physicians can perform limited ultrasound examinations. A multipurpose ultrasound system is installed on the International Space Station (ISS) as a component of the Human Research Facility (HRF). This report documents the first ocular ultrasound examination conducted in space, which demonstrated the capability to assess physiologic alterations or pathology including trauma during long-duration space flight. METHODS: An ISS crewmember with minimal sonography training was remotely guided by an imaging expert from Mission Control Center (MCC) through a comprehensive ultrasound examination of the eye. A multipurpose ultrasound imager was used in conjunction with a space-to-ground video downlink and two-way audio. Reference cards with topological reference points, hardware controls, and target images were used to facilitate the examination. Multiple views of the eye structures were obtained through a closed eyelid. Pupillary response to light was demonstrated by modifying the light exposure of the contralateral eye. RESULTS: A crewmember on the ISS was able to complete a comprehensive ocular examination using B- and M-mode ultrasonography with remote guidance from an expert in the MCC. Multiple anteroposterior, oblique, and coronal views of the eye clearly demonstrated the anatomic structures of both segments of the globe. The iris and pupil were readily visualized with probe manipulation. Pupillary diameter was assessed in real time in B- and M-mode displays. The anatomic detail and fidelity of ultrasound video were excellent and could be used to answer a variety of clinical and space physiologic questions. CONCLUSIONS: A comprehensive, high-quality ultrasound examination of the eye was performed with a multipurpose imager aboard the ISS by a non-expert operator using remote guidance. Ocular ultrasound images were of diagnostic quality despite the 2-second communication latency and the unconventional setting of a weightless spacecraft environment. The remote guidance techniques developed to facilitate this successful NASA research experiment will support wider applications of ultrasound for remote medicine on Earth including the assessment of pupillary reactions in patients with severe craniofacial trauma and swelling.

Clinical Trial↗

DOE OSTI2022

Systems and methods for plane-wave and fan-beam ultrasound-waveform tomography

A method for plane-wave or fan-beam ultrasound tomography includes: controlling, by a processor, a multi-channel ultrasound array controller to control a linear ultrasound transducer array to emit plane-wave or fan-beam ultrasound into a biological tissue, the linear ultrasound transducer array including a plurality of transducers; receiving, by the processor, plane-wave or fan-beam ultrasound waveform data from the transducers, the plane-wave or fan-beam ultrasound waveform data including reflections of the plane-wave or fan-beam ultrasound from the biological tissue; computing, by the processor, a synthetic ultrasound-waveform inversion from the received plane-wave or fan-beam ultrasound waveform data; and computing, by the processor, an image of the biological tissue from the synthetic ultrasound-waveform inversion.

Huang, Lianjie↗

DOE OSTI2018

Thermoacoustic range verification in the presence of acoustic heterogeneity and soundspeed errors - Robustness relative to ultrasound image of underlying anatomy

Purpose: To demonstrate robustness of thermooacoustic range verification to acoustic heterogeneity and discrepancies between assumed and true propagation speed, i.e., soundspeed errors. Methods: A beam sweeper was used to deliver 250 ns pulses that deposited 0.26 Gy of 16 MeV protons and 2.3 Gy of 60 MeV helium ions into water and oil targets, respectively. Thermoacoustic signals were detected by a 96-channel ultrasound array with a 1-4 MHz sensitivity band (-6 dB), bandpass filtered and backprojected to create thermoacoustic images in the plane of the ultrasound array. The same soundspeed and transducer array were used to estimate range and generate the ultrasound images onto which Bragg peak locations were overlaid. An air-gap phantom that displaced the Bragg peak by 6.5 mm demonstrated accuracy. Robustness to soundspeed errors was demonstrated in a waterbath as the assumed propagation speed scanner setting was altered by +/- 5%. Tissue-mimicking gelatin and a bone sample were introduced to demonstrate robustness to acoustic heterogeneity relative to ultrasound images of the underlying morphology. Results: Single ion pulse measurements sufficed during the helium run, but signal averaging was required for protons. Moreover, range and entry point into the target were estimated from data collected by transducers placed at least 6 cm distal to the Bragg peak. When ultrasound images depicted the air-target interface where the beam enters, estimates of the entry point agreed with ultrasound images and range estimates agreed with Monte Carlo simulations to within 300 mu m, even when thermoacoustic emissions traveled through a strongly scattering bone sample. Estimated Bragg peak locations were translated 6.5 mm by the air-gap phantom and correctly identified scenarios when the beam stopped inside the bone. Conclusions: Soundspeed errors dilate and acoustic heterogeneities deform ultrasound images. When thermoacoustic receivers are co-located with the ultrasound imaging array, the same transformations shift thermoacoustic range estimates. Hence, thermoacoustic range verification is robust relative to ultrasound images of underlying anatomy. When the treatment target is visible in ultrasound, e.g., prostate, online thermoacoustic range estimates could verify that the treatment spot is inside the target.

47 OTHER INSTRUMENTATION↗

DOE OSTI2015

SU-E-J-42: Evaluation of Fiducial Markers for Ultrasound and X-Ray Images Used for Motion Tracking in Pancreas SBRT

Purpose Ultrasound tracking of target motion relies on visibility of vascular and/or anatomical landmark. However this is challenging when the target is located far from vascular structures or in organs that lack ultrasound landmark structure, such as in the case of pancreas cancer. The purpose of this study is to evaluate visibility, artifacts and distortions of fusion coils and solid gold markers in ultrasound, CT, CBCT and kV images to identify markers suitable for real-time ultrasound tracking of tumor motion in SBRT pancreas treatment. Methods Two fusion coils (1mm × 5mm and 1mm × 10 mm) and a solid gold marker (0.8mm × 10mm) were embedded in a tissue–like ultrasound phantom. The phantom (5cm × 12cm × 20cm) was prepared using water, gelatin and psyllium-hydrophilic-mucilloid fiber. Psylliumhydrophilic mucilloid acts as scattering medium to produce echo texture that simulates sonographic appearance of human tissue in ultrasound images while maintaining electron density close to that of water in CT images. Ultrasound images were acquired using 3D-ultrasound system with markers embedded at 5, 10 and 15mm depth from phantom surface. CT images were acquired using Philips Big Bore CT while CBCT and kV images were acquired with XVI-system (Elexta). Visual analysis was performed to compare visibility of the markers and visibility score (1 to 3) were assigned. Results All markers embedded at various depths are clearly visible (score of 3) in ultrasound images. Good visibility of all markers is observed in CT, CBCT and kV images. The degree of artifact produced by the markers in CT and CBCT images are indistinguishable. No distortion is observed in images from any modalities. Conclusion All markers are visible in images across all modalities in this homogenous tissue-like phantom. Human subject data is necessary to confirm the marker type suitable for real-time ultrasound tracking of tumor motion in SBRT pancreas treatment.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

MO-DE-210-07: Investigation of Treatment Interferences of a Novel Robotic Ultrasound Radiotherapy Guidance System with Clinical VMAT Plans for Liver SBRT Patients

Purpose: To evaluate the proportion of liver SBRT cases in which robotic ultrasound image guidance concurrent with beam delivery can be deployed without interfering with clinically used VMAT beam configurations. Methods: A simulation environment incorporating LINAC, couch, planning CT, and robotic ultrasound guidance hardware was developed. Virtual placement of the robotic ultrasound hardware was guided by a target visibility map rendered on the CT surface. The map was computed on GPU by using the planning CT to simulate ultrasound propagation and attenuation along rays connecting skin surface points to a rasterized imaging target. The visibility map was validated in a prostate phantom experiment by capturing live ultrasound images of the prostate from different phantom locations. In 20 liver SBRT patients treated with VMAT, the simulation environment was used to place the robotic hardware and ultrasound probe at imaging locations indicated on the visibility map. Imaging targets were either entire PTV (range 5.9–679.5 ml) or entire GTV (range 0.9–343.4 ml). Presence or absence of mechanical collisions with LINAC, couch, and patient body as well as interferences with treated beams were recorded. Results: For PTV targets, robotic ultrasound guidance without mechanical collision was possible in 80% of the cases and guidance without beam interference was possible in 60% of the cases. For the smaller GTV targets, these proportions were 95% and 85% correspondingly. GTV size (1/20), elongated shape (1/20), and depth (1/20) were the main factors limiting the availability of non-interfering imaging positions. Conclusion: This study indicates that for VMAT liver SBRT, robotic ultrasound tracking of a relevant internal target would be possible in 85% of cases while using treatment plans currently deployed in the clinic. With beam re-planning in accordance with the presence of robotic ultrasound guidance, intra-fractional ultrasound guidance may be an option for 95% of the liver SBRT cases. This project was funded by NIH Grant R41CA174089.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2019

Ultrasound versus computed tomography for the detection of ureteral calculi in the pediatric population: a clinical effectiveness study

Objective: To determine the diagnostic performance of ultrasound for diagnosing ureteral calculi in children using a clinical effectiveness approach. Methods: Billing records and imaging reports were used to identify children (≤ 18 years old) evaluated for suspected urolithiasis using ultrasound between March 2012 and March 2017. Patients without unenhanced CT within 24 h (reference standard) were excluded. Imaging (ultrasound and CT) reports were reviewed for presence, number, size, and location of calculi. Diagnostic performance of ultrasound (versus CT) was calculated on an individual ureter basis both by direct calculus visualization as well as direct visualization combined with suspected presence of ureteral stone based on indirect ultrasound findings. Results: 41 ureteral calculi were present in 38 of 69 (55.1%) patients. Mean patient age was 14.7 ± 3.6 years, and 35 of 69 (51%) patients were boys. Based on direct calculus visualization, ultrasound had a sensitivity of 12.8% (95% CI 5.6–26.7%), specificity of 100% (95% CI 96.3–100%), positive predictive value (PPV) of 100% (95% CI 56.6–100%), and negative predictive value (NPV) of 74.4% (95% CI 66.4–81.1%). When ultrasound examinations reported as suspicious for ureteral calculi based on indirect findings also were considered positive, ultrasound had a sensitivity of 41.0% (95% CI 27.1–56.6%), specificity of 95.0% (95% CI 88.7–97.8%), PPV of 76.2% (95% CI 54.9–89.4%), and NPV of 80.3% (95% CI 72.2–86.5%). Conclusions: In clinical practice, ultrasound has low sensitivity for directly visualizing ureteral calculi subsequently identified by CT, although sensitivity improves when considering suspicious examinations as positive.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2015

MO-DE-210-03: Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities

Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities. It is inexpensive, portable and provides good soft tissue contrast. For challenging soft tissue targets such as pancreatic cancer, ultrasound imaging can be used in combination with pre-treatment MRI and/or CT to transfer important anatomical features for target localization at time of treatment. The non-invasive and non-ionizing nature of ultrasound imaging is particularly powerful for intra-fraction localization and monitoring. Recognizing these advantages, efforts are being made to incorporate novel robotic approaches to position and manipulate the ultrasound probe during irradiation. These recent enabling developments hold potential to bring ultrasound imaging to a new level of IGRT applications. However, many challenges, not limited to image registration, robotic deployment, probe interference and image acquisition rate, need to be addressed to realize the full potential of IGRT with ultrasound imaging. Learning Objectives: Understand the benefits and limitations in using ultrasound to augment MRI and/or CT for motion monitoring during radiation therapy delivery. Understanding passive and active robotic approaches to implement ultrasound imaging for intra-fraction monitoring. Understand issues of probe interference with radiotherapy treatment. Understand the critical clinical workflow for effective and reproducible IGRT using ultrasound guidance. The work of X.L. is supported in part by Elekta; J.W. and K.D. is supported in part by a NIH grant R01 CA161613 and by Elekta; D.H. is support in part by a NIH grant R41 CA174089.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-EF-210-04: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy

The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imaging Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.

60 APPLIED LIFE SCIENCES↗