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DOE OSTI2014

Ultrasound assisted biogas production from landfill leachate

Highlights: • Effect of low frequency ultrasound pretreatment on leachate was investigated. • Three different ultrasound energy inputs (200, 400 and 600 W/l) was applied. • Low-frequency ultrasound treatment increased soluble COD in landfill leachate. • Application of ultrasound to leachate increased biogas production about 40%. • Application of ultrasound to leachate increased total methane production rate about 20%. - Abstract: The aim of this study is to increase biogas production and methane yield from landfill leachate in anaerobic batch reactors by using low frequency ultrasound as a pretreatment step. In the first part of the study, optimum conditions for solubilization of organic matter in leachate samples were investigated using various sonication durations at an ultrasound frequency of 20 kHz. The level of organic matter solubilization during ultrasonic pretreatment experiments was determined by calculating the ratio of soluble chemical oxygen demand (sCOD) to total chemical oxygen demand (tCOD). The sCOD/tCOD ratio was increased from 47% in raw leachate to 63% after 45 min sonication at 600 W/l. Non-parametric Friedman’s test indicated that ultrasonic pretreatment has a significant effect on sCOD parameter for leachate (p < 0.05). In the second part of the study, anaerobic batch reactors were operated for both ultrasonically pretreated and untreated landfill leachate samples in order to assess the effect of sonication on biogas and methane production rate. In anaerobic batch reactor feed with ultrasonically pretreated leachate, 40% more biogas was obtained compared to the control reactor. For statistical analysis, Mann–Whitney U test was performed to compare biogas and methane production rates for raw and pretreated leachate samples and it has been found that ultrasonic pretreatment significantly enhanced biogas and methane production rates from leachate (p < 0.05) in anaerobic batch reactors. The overall results showed that low frequency ultrasound pretreatment can be potentially used for wastewater management especially with integration of anaerobic processes.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2021

On the Bandwidth and Beam Profile Characteristics of a Simple Low-Frequency Collimated Ultrasound Beam Source

We numerically investigate the bandwidth and collimation characteristics of ultrasound beams generated by a simple collimated ultrasound beam source that consists of a piezoelectric disk operated near its radial mode resonances. We simulate the ultrasound beam generated in a fluid medium as a function of the excitation frequency for two cases: (1) free piezoelectric disk that corresponds to zero-traction along the lateral edge and (2) fixed piezoelectric disk that corresponds to zero-displacement along the lateral edge. We present and discuss the physical mechanism underpinning the frequency-dependent collimation and bandwidth properties of the ultrasound beams. We observe that the collimated beam generated by the free disk repeatedly lengthens/shortens and also extends/retracts sidelobes with increasing frequency. Alternatively, fixing the piezoelectric disk results in a consistent beam profile shape across a broad range of frequencies. This facilitates generating broadband signals such as a Gaussian pulse or chirp, which are common in ultrasound imaging. Thus, the fixed piezoelectric disk finds application as a collimated ultrasound beam source in a wide range of applications including medical ultrasound imaging, scanning acoustic microscopy, sonar detection, and other nondestructive ultrasound inspection techniques.

47 OTHER INSTRUMENTATION↗

DOE OSTI2014

SU-E-J-114: Towards Integrated CT and Ultrasound Guided Radiation Therapy Using A Robotic Arm with Virtual Springs

Purpose: Currently there is an urgent need in Radiation Therapy for noninvasive and nonionizing soft tissue target guidance such as localization before treatment and continuous monitoring during treatment. Ultrasound is a portable, low cost option that can be easily integrated with the LINAC room. We are developing a cooperatively controlled robot arm that has high intrafraction reproducibility with repositioning of the ultrasound probe. In this study, we introduce virtual springs (VS) to assist with interfraction probe repositioning and we compare the soft tissue deformation introduced by VS to the deformation that would exist without them. Methods: Three metal markers were surgically implanted in the kidney of one dog. The dog was anesthetized and immobilized supine in an alpha cradle. The reference ultrasound probe position and force to ideally visualize the kidney was defined by an experienced ultrasonographer using the Clarity ultrasound system and robot sensor. For each interfraction study, the dog was removed from the cradle and re-setup based on CBCT with bony anatomy alignment to mimic regular patient setup. The ultrasound probe was automatically returned to the reference position using the robot. To accommodate the soft tissue anatomy changes between each setup the operator used the VS feature to adjust the probe and obtain an ultrasound image that matched the reference image. CBCT images were acquired and each interfraction marker location was compared with the first interfraction Result. Results: Analysis of the marker positions revealed that the kidney was displaced by 18.8 ± 6.4 mm without VS and 19.9 ± 10.5 mm with VS. No statistically significant differences were found between two procedures. Conclusion: The VS feature is necessary to obtain matching ultrasound images, and they do not introduce further changes to the tissue deformation. Future work will focus on automatic VS based on ultrasound feedback. Supported in part by: NCI R01 CA161613; Elekta Sponsored Research.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

TU-A-9A-06: Semi-Automatic Segmentation of Skin Cancer in High-Frequency Ultrasound Images: Initial Comparison with Histology

Purpose: In skin-cancer radiotherapy, the assessment of skin lesion is challenging, particularly with important features such as the depth and width hard to determine. The aim of this study is to develop interative segmentation method to delineate tumor boundary using high-frequency ultrasound images and to correlate the segmentation results with the histopathological tumor dimensions. Methods: We analyzed 6 patients who comprised a total of 10 skin lesions involving the face, scalp, and hand. The patient’s various skin lesions were scanned using a high-frequency ultrasound system (Episcan, LONGPORT, INC., PA, U.S.A), with a 30-MHz single-element transducer. The lateral resolution was 14.6 micron and the axial resolution was 3.85 micron for the ultrasound image. Semiautomatic image segmentation was performed to extract the cancer region, using a robust statistics driven active contour algorithm. The corresponding histology images were also obtained after tumor resection and served as the reference standards in this study. Results: Eight out of the 10 lesions are successfully segmented. The ultrasound tumor delineation correlates well with the histology assessment, in all the measurements such as depth, size, and shape. The depths measured by the ultrasound have an average of 9.3% difference comparing with that in the histology images. The remaining 2 cases suffered from the situation of mismatching between pathology and ultrasound images. Conclusion: High-frequency ultrasound is a noninvasive, accurate and easy-accessible modality to image skin cancer. Our segmentation method, combined with high-frequency ultrasound technology, provides a promising tool to estimate the extent of the tumor to guide the radiotherapy procedure and monitor treatment response.

60 APPLIED LIFE SCIENCES↗

NASA NTRS1999

Ultrasound Thermal Field Imaging of Opaque Fluids

We have initiated an experimental program to develop an ultrasound system for non-intrusively imaging the thermal field in opaque fluids under an externally imposed temperature gradient. Many industrial processes involve opaque fluids, such as molten metals, semiconductors, and polymers, often in situations in which thermal gradients are important. For example, one may wish to understand semiconductor crystal growth dynamics in a Bridgman apparatus. Destructive testing of the crystal after the process is completed gives only indirect information about the fluid dynamics of the formation process. Knowledge of the coupled thermal and velocity fields during the growth process is then essential. Most techniques for non-intrusive velocity and temperature measurement in fluids are optical in nature, and hence the fluids studied must be transparent. In some cases (for example, LDV (laser Doppler velocimetry) and PIV (particle imaging velocimetry)) the velocities of small neutrally buoyant seed particles suspended in the fluid, are measured. Without particle seeding one can use the variation of the index of refraction of the fluid with temperature to visualize, through interferometric, Schlieren or shadowgraph techniques, the thermal field. The thermal field in turn gives a picture of the pattern existing in the fluid. If the object of study is opaque, non-optical techniques must be used. In this project we focus on the use of ultrasound, which propagates easily through opaque liquids and solids. To date ultrasound measurements have almost exclusively relied on the detection of sound scattered from density discontinuities inside the opaque material of interest. In most cases it has been used to visualize structural properties, but more recently the ultrasound Doppler velocimeter has become available. As in the optical case, it relies on seed particles that scatter Doppler shifted sound back to the detector. Doppler ultrasound techniques are, however, not useful for studying convective fluid flow in crystal growth, because particle seeding is unacceptable and flow velocities are typically too low to be resolved, and may be even lower in microgravity conditions where buoyancy forces are negligible. We will investigate a different use of ultrasound to probe the flows of opaque fluids non-intrusively and without the use of seed particles: our goal is to ultrasonically visualize the thermal field of opaque fluids with relatively high spatial resolution. The proposed technique relies upon the variation of sound speed with temperature of the fluid. A high frequency ultra-sound pulse passing through a fluid-filled chamber will traverse the chamber in a time determined by the relevant chamber dimension and the temperature of the fluid through which the pulse passes. With high time-resolution instrumentation that compares the excitation signal with the received pulse we can detect the influence of the fluid temperature on the pulse travel time. This is effectively an interferometric system, which in its optical form is an extremely sensitive approach to measuring thermal fields in fluids. Moreover, the temperature dependence of sound velocity in liquid metals is comparable to the temperature dependence of the speed of light required for accurate interferometric thermal images in transparent fluids. With an array of transducers scanned electronically a map of the thermal field over the chamber could be produced. An alternative approach would be to use the ultrasound analog of the shadowgraph technique. In the optical version, collimated light passes through the fluid, where it is focused or defocused locally by temperature field induced variations of the index of refraction. The resulting image reveals the thermal field through the spatial pattern of light intensity variations. By analogy, an ultrasound plane wave traversing an opaque fluid sample would be also locally focused or defocused depending on the speed of sound variations, giving rise to spatial variations in sound intensity that will reveal the thermal field pattern. These approaches could be applied to any situation in which temperature differences are expected to occur, and will rapidly provide information about the flow that simply cannot be obtained by any current intrusive or non-intrusive diagnostic technique. As materials processing in microgravity matures it will become increasingly important to have available simple and versatile diagnostic tools, such as we will develop, for studying the flows of opaque fluids under thermal forcing.

Andereck, C. David↗

NASA NTRS2006

Validation of Ultrasound Imaging to Rule-out Thoracic Trauma on the International Space Station

Introduction: Aboard the International Space Station (ISS) an intra-thoracic injury may be disastrous to the crew member if the diagnosis is missed or even delayed. Pneumothorax and hemothorax commonly seen in trauma patients; the diagnosis is usually confirmed by chest X-ray or computed tomography. In this study, the ability of ultrasound to rule out pneumothorax by the presence "lung sliding" and hemothorax by the absence of pleural fluid was validated. Methods: The research activities were approved by the NASA Johnson Space Center Committee for the Protection of Human Subjects, and the participating crewmembers signed informed consent prior to the activity. ISS crewmembers received 2-hours of "hands on" ultrasound training 8 months prior to the on-orbit ultrasound exam. Baseline ultrasound images of the thorax were acquired on the crewmebers of Increment 8 and 9 prior to launch from Bakonur, Russia. Ultrasound examination of the thorax were performed on crewmembers at 30 day intervals (n=??) throughout their flight. Post flight images were acquired on or about landing day 10. Ultrasound images were acquired using the ISS Health Research Facility ultrasound system and examined by experts on the ground to rule out the presence of pneumothorax and hemothorax. Results: The presence of "lung sliding" which excludes pneumothorax, was seen in all subjects. The absence of pleural fluid, which excludes hemothorax was seen in all subjects. The optimal position between sonographer and patient under microgravity conditions and the amount and type of training for a non-physician crew medical officer for these procedures was also established for this procedure. Conclusion: Ultrasound can be performed on orbit under microgravity condition to rule thoracic trauma, such as pneumothorax and hemothorax.

Hamilton, Douglas R.↗

NASA NTRS2009

Smart Ultrasound Remote Guidance Experiment (SURGE) Preliminary Findings

To date, diagnostic quality ultrasound images were obtained aboard the International Space Station (ISS) using the ultrasound of the Human Research Facility (HRF) rack in the Laboratory module. Through the Advanced Diagnostic Ultrasound in Microgravity (ADUM) and the Braslet-M Occlusion Cuffs (BRASLET SDTO) studies, non-expert ultrasound operators aboard the ISS have performed cardiac, thoracic, abdominal, vascular, ocular, and musculoskeletal ultrasound assessments using remote guidance from ground-based ultrasound experts. With exploration class missions to the lunar and Martian surfaces on the horizon, crew medical officers will necessarily need to operate with greater autonomy given communication delays (round trip times of up to 5 seconds for the Moon and 90 minutes for Mars) and longer periods of communication blackouts (due to orbital constraints of communication assets). The SURGE project explored the feasibility and training requirements of having non-expert ultrasound operators perform autonomous ultrasound assessments in a simulated exploration mission outpost. The project aimed to identify experience, training, and human factors requirements for crew medical officers to perform autonomous ultrasonography. All of these aims pertained to the following risks from the NASA Bioastronautics Road Map: 1) Risk 18: Major Illness and Trauna; 2) Risk 20) Ambulatory Care; 3) Risk 22: Medical Informatics, Technologies, and Support Systems; and 4) Risk 23: Medical Skill Training and Maintenance.

Hurst, Victor↗

NASA NTRS2012

Virtual Ultrasound Guidance for Inexperienced Operators

Medical ultrasound or echocardiographic studies are highly operator-dependent and generally require lengthy training and internship to perfect. To obtain quality echocardiographic images in remote environments, such as on-orbit, remote guidance of studies has been employed. This technique involves minimal training for the user, coupled with remote guidance from an expert. When real-time communication or expert guidance is not available, a more autonomous system of guiding an inexperienced operator through an ultrasound study is needed. One example would be missions beyond low Earth orbit in which the time delay inherent with communication will make remote guidance impractical. The Virtual Ultrasound Guidance system is a combination of hardware and software. The hardware portion includes, but is not limited to, video glasses that allow hands-free, full-screen viewing. The glasses also allow the operator a substantial field of view below the glasses to view and operate the ultrasound system. The software is a comprehensive video program designed to guide an inexperienced operator through a detailed ultrasound or echocardiographic study without extensive training or guidance from the ground. The program contains a detailed description using video and audio to demonstrate equipment controls, ergonomics of scanning, study protocol, and scanning guidance, including recovery from sub-optimal images. The components used in the initial validation of the system include an Apple iPod Classic third-generation as the video source, and Myvue video glasses. Initially, the program prompts the operator to power-up the ultrasound and position the patient. The operator would put on the video glasses and attach them to the video source. After turning on both devices and the ultrasound system, the audio-video guidance would then instruct on patient positioning and scanning techniques. A detailed scanning protocol follows with descriptions and reference video of each view along with advice on technique. The program also instructs the operator regarding the types of images to store and how to overcome pitfalls in scanning. Images can be forwarded to the ground or other site when convenient. Following study completion, the video glasses, video source, and ultrasound system are powered down and stored. Virtually any equipment that can play back video can be used to play back the program. This includes a DVD player, personal computer, and some MP3 players.

Caine, Timothy↗

NASA NTRS2016

Modifying a Commercial Centrifuge to Reduce Electromagnetic Interference and Evaluating Functionality of Ultrasound Equipment

The Project Management and Engineering Branch (SF4) supports the Human Health and Performance Directorate (HH&P) and is responsible for developing and supporting human systems hardware for the International Space Station (ISS). When a principal investigator's (PI) medical research project on the ISS is accepted, SF4 develops the necessary hardware and software to transport to the ISS. The two projects I primarily worked on were the centrifuge and ultrasound projects. Centrifuge: One concern with spacecraft such as the ISS is electromagnetic interference (EMI) from onboard equipment, typically from radio waves (frequencies of ~3 kHz to ~300 GHz), which can negatively affect nearby circuitry. Standard commercial centrifuges produce EMI above safety limits, so my task was to help reduce EMI production from this equipment. Two centrifuges were tested: one unmodified as a control and one modified. To reduce EMI below safety limits, one centrifuge was modified to become a Faraday shield, in which significant electrical contact was made between all regions of the centrifuge housing. This included removing non-conductive paint, applying conductive fabric to the lid and foam sealer, adding a 10,000 μF decoupling capacitor across the power supply, and adding copper adhesive-mount gaskets to the housing interior. EMI testing of both centrifuges was performed in the EMI/EMC Control Test and Measurement Facility. EMI for both centrifuges was below safety limits for frequencies between 10 MHz and 15 GHz (pass); however, between 14 kHz and 10 MHz, EMI for the unmodified centrifuge exceeded safety limits (fail) as expected. Alternatively, for the modified centrifuge with the Faraday shield, EMI was below the safely limit of 55 dBμV/m for electromagnetic frequencies between 14 kHz and 10 MHz. This result indicates our modifications were successful. The successful EMI test allowed us to communicate with the vendor what modifications they needed to make to their commercial unit to meet our specifications and to understand what needs to be done in lab to the new centrifuge. Our modifications will provide a standard for readying centrifuges for future missions. Once the new modified centrifuge arrives by the vendor, it will need to undergo EMI testing again for validation. The centrifuge is also in the process of compatibility testing with a custom stowage drawer, which is an ongoing project in SF4. Both of these items will be payloads on future missions to the ISS for various research purposes. Ultrasound: ISS currently has an onboard ultrasound (Ultrasound 2 system) for research and medical purposes. Every piece of medical flight hardware has an equivalent ground-unit so instrumentation can be routinely evaluated and transported to the ISS if necessary. The ground-unit ultrasound equipment must be evaluated every six months using a task performance sheet (TPS). A TPS is a document, written by the appropriate scientists and engineers, which describes how to run equipment and is written in such a way that astronauts with unspecialized training can follow the tasks. I was responsible for performing six TPSs on a combination of three ultrasounds and two video power converters (VPCs). Performing a TPS involves checking out and computationally documenting each piece of equipment removed from storage locations, setting up hardware and software, performing tasks to verify functionality, returning equipment, and logging items back into the computerized system. My work revealed all ground-unit ultrasounds were functioning properly. Because of proper function, a discrepancy report (DR) did not have to be opened. The TPS was then passed along to the Quality Engineering (QE) for review and ultimately given to Quality Assurance (QA). Other projects: In addition to my main projects, I participated in other tasks including troubleshooting an EEG headband, volunteering for an ultrasound training research study, and conformal coating printed circuit boards. My internship at SF4 has helped me understand how space systems hardware development for the ISS fits into NASA's mission and vision.

Greening, Gage J.↗

DOE OSTI2014

Focused ultrasound treatment of abscesses induced by methicillin resistant Staphylococcus aureus: Feasibility study in a mouse model

Purpose: To study the therapeutic effect of focused ultrasound on abscesses induced by methicillin-resistantStaphylococcus aureus (MRSA). MRSA is a major nosocomial pathogen where immunocompromised patients are prone to develop infections that are less and less responsive to regular treatments. Because of its capability to induce a rise of temperature at a very precise location, the use of focused ultrasound represents a considerable opportunity for therapy of localized MRSA-related infections. Methods: 50μl of MRSA strain USA400 bacteria suspension at a concentration of 1.32 ± 0.5 × 10{sup 5} colony forming units (cfu)/μl was injected subcutaneously in the left flank of BALB/c mice. An abscess of 6 ± 2 mm in diameter formed after 48 h. A transducer operating at 3 MHz with a focal length of 50 mm and diameter of 32 mm was used to treat the abscess. The focal point was positioned 2 mm under the skin at the abscess center. Forty-eight hours after injection four ultrasound exposures of 9 s each were applied to each abscess under magnetic resonance imaging guidance. Each exposure was followed by a 1 min pause. These parameters were based on preliminary experiments to ensure repetitive accurate heating of the abscess. Real-time estimation of change of temperature was done using water-proton resonance frequency and a communication toolbox (matMRI) developed inhouse. Three experimental groups of animals each were tested: control, moderate temperature (MT), and high temperature (HT). MT and HT groups reached, respectively, 52.3 ± 5.1 and 63.8 ± 7.5 °C at the end of exposure. Effectiveness of the treatment was assessed by evaluating the bacteria amount of the treated abscess 1 and 4 days after treatment. Myeloperoxidase (MPO) assay evaluating the neutrophil amount was performed to assess the local neutrophil recruitment and the white blood cell count was used to evaluate the systemic inflammatory response after focused ultrasound treatment. Results: Macroscopic evaluation of treated abscess indicated a diminution of external size of abscess 1 day after treatment. Treatment did not cause open wounds. The median (lower to upper quartile) bacterial count 1 day after treatment was 6.18 × 10{sup 3} (0.76 × 10{sup 3}–11.18 × 10{sup 3}), 2.86 × 10{sup 3} (1.22 × 10{sup 3}–7.07 × 10{sup 3}), and 3.52 × 10{sup 3} (1.18 × 10{sup 3}–6.72 × 10{sup 3}) cfu/100 μl for control, MT and HT groups, respectively; for the 4-day end point, the count was 1.37 × 10{sup 3} (0.67 × 10{sup 3}–2.89 × 10{sup 3}), 1.35 × 10{sup 3} (0.09 × 10{sup 3}–2.96 × 10{sup 3}), and 0.07 × 10{sup 3} (0.03 × 10{sup 3}–0.36 × 10{sup 3}) cfu/100 μl for control, MT and HT, showing a significant reduction (p = 0.002) on the bacterial load four days after focused ultrasound treatment when treating at high temperature (HT). The MPO amount remained unchanged between groups and days, indicating no change on local neutrophil recruitment in the abscess caused by the treatment. The white blood cell count remained unchanged between groups and days indicating that no systemic inflammatory response was caused by the treatment. Conclusions: Focused ultrasound induces a therapeutic effect in abscesses induced by MRSA. This effect is observed as a reduction of the number bacteria without significantly altering the amount of MPO at the site of a MRSA-induced abscess. These initial results suggest that focused ultrasound is a viable option for the treatment of localized MRSA-related infections.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2014

WE-A-18C-01: Emerging and Innovative Ultrasound Technology in Diagnosis and Therapy

The application of new ultrasound-based technologies in medicine has expanded in recent years. One area of rapid growth has been the combination of ultrasound with other methods of image generation and imaging modalities to produce hybrid approaches for diagnostic imaging and noninvasive therapeutic intervention. The presentations associated with this session will provide an overview of two emerging technologies that are currently being developed and implemented to enhance ultrasound-related diagnostic imaging and therapy: the utilization of optically-induced ultrasound imaging (optoacoustic / photoacoustic imaging) and the use of magnetic resonance imaging to guide the use of high-intensity focused ultrasound for therapeutic applications. Learning Objectives: Develop a general understanding of the underlying technologies associated with optoacoustic / photoacoustic tomography and MRguided high-intensity focused ultrasound. Develop an understanding of the current methods of these new ultrasound-based technologies in preclinical research and clinical applications.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

Motion tracking in the liver: Validation of a method based on 4D ultrasound using a nonrigid registration technique

Purpose: Treatments like radiotherapy and focused ultrasound in the abdomen require accurate motion tracking, in order to optimize dosage delivery to the target and minimize damage to critical structures and healthy tissues around the target. 4D ultrasound is a promising modality for motion tracking during such treatments. In this study, the authors evaluate the accuracy of motion tracking in the liver based on deformable registration of 4D ultrasound images. Methods: The offline analysis was performed using a nonrigid registration algorithm that was specifically designed for motion estimation from dynamic imaging data. The method registers the entire 4D image data sequence in a groupwise optimization fashion, thus avoiding a bias toward a specifically chosen reference time point. Three healthy volunteers were scanned over several breathing cycles (12 s) from three different positions and angles on the abdomen; a total of nine 4D scans for the three volunteers. Well-defined anatomic landmarks were manually annotated in all 96 time frames for assessment of the automatic algorithm. The error of the automatic motion estimation method was compared with interobserver variability. The authors also performed experiments to investigate the influence of parameters defining the deformation field flexibility and evaluated how well the method performed with a lower temporal resolution in order to establish the minimum frame rate required for accurate motion estimation. Results: The registration method estimated liver motion with an error of 1 mm (75% percentile over all datasets), which was lower than the interobserver variability of 1.4 mm. The results were only slightly dependent on the degrees of freedom of the deformation model. The registration error increased to 2.8 mm with an eight times lower temporal resolution. Conclusions: The authors conclude that the methodology was able to accurately track the motion of the liver in the 4D ultrasound data. The authors believe that the method has potential in interventions on moving abdominal organs such as MR or ultrasound guided focused ultrasound therapy and radiotherapy, pending the method is enabled to run in real-time. The data and the annotations used for this study are made publicly available for those who would like to test other methods on 4D liver ultrasound data.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

Verification and compensation of respiratory motion using an ultrasound imaging system

Purpose: The purpose of this study was to determine if it is feasible to use ultrasound imaging as an aid for moving the treatment couch during diagnosis and treatment procedures associated with radiation therapy, in order to offset organ displacement caused by respiratory motion. A noninvasive ultrasound system was used to replace the C-arm device during diagnosis and treatment with the aims of reducing the x-ray radiation dose on the human body while simultaneously being able to monitor organ displacements. Methods: This study used a proposed respiratory compensating system combined with an ultrasound imaging system to monitor the compensation effect of respiratory motion. The accuracy of the compensation effect was verified by fluoroscopy, which means that fluoroscopy could be replaced so as to reduce unnecessary radiation dose on patients. A respiratory simulation system was used to simulate the respiratory motion of the human abdomen and a strain gauge (respiratory signal acquisition device) was used to capture the simulated respiratory signals. The target displacements could be detected by an ultrasound probe and used as a reference for adjusting the gain value of the respiratory signal used by the respiratory compensating system. This ensured that the amplitude of the respiratory compensation signal was a faithful representation of the target displacement. Results: The results show that performing respiratory compensation with the assistance of the ultrasound images reduced the compensation error of the respiratory compensating system to 0.81–2.92 mm, both for sine-wave input signals with amplitudes of 5, 10, and 15 mm, and human respiratory signals; this represented compensation of the respiratory motion by up to 92.48%. In addition, the respiratory signals of 10 patients were captured in clinical trials, while their diaphragm displacements were observed simultaneously using ultrasound. Using the respiratory compensating system to offset, the diaphragm displacement resulted in compensation rates of 60%–84.4%. Conclusions: This study has shown that a respiratory compensating system combined with noninvasive ultrasound can provide real-time compensation of the respiratory motion of patients.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-D-210-06: Feasibility for Monitoring the Head of the Pancreas Motion Through a Surrogate Using Ultrasound During Radiation Therapy Delivery

Purpose: Substantial target motion during the delivery of radiation therapy (RT) for pancreatic cancer is well recognized as a major limiting factor on RT effectiveness. The aim of this work is to monitor intra-fractional motion of the pancreas using ultrasound during RT delivery. Methods: Transabdominal Ultrasound B-mode images were collected from 5 volunteers using a research version of the Clarity Autoscan System (Elekta). The autoscan transducer with center frequency of 5 MHz was utilized for the scans. Imaging parameters were adjusted to acquire images at the desired depth with good contrast and a wide sweep angle. Since well-defined boundaries of the pancreas can be difficult to find on ultrasound B-mode images, the portal vein was selected as a surrogate for motion estimation of the head of the pancreas. The selection was due to its anatomical location posterior to the neck of the pancreas and close proximity to the pancreas head. The portal vein was contoured on the ultrasound images acquired during simulation using the Clarity Research AFC Workstation software. Volunteers were set up in a similar manner to the simulation for their monitoring session and the ultrasound transducer was mounted on an arm fixed to the couch. A video segment of the portal vein motion was captured. Results: The portal vein was visualized and segmented. Successful monitoring sessions of the portal vein were observed. In addition, our results showed that the ultrasound transducer itself reduces breathing related motion. This is analogous to the use of a compression plate to suppress respiration motion during thorax or abdominal irradiation. Conclusion: We demonstrate the feasibility of tracking the pancreas through the localization of the portal vein using abdominal ultrasound. This will allow for real-time tracking of the intra-fractional motion to justify PTV-margin and to account for unusual motions, thus, improving normal tissue sparing. This research was funding in part by Elekta Inc.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP3-08: Robotic System for Ultrasound Tracking in Radiation Therapy

Purpose: For safe and accurate real-time tracking of tumors for IGRT using 4D ultrasound, it is necessary to make use of novel, high-end force-sensitive lightweight robots designed for human-machine interaction. Such a robot will be integrated into an existing robotized ultrasound system for non-invasive 4D live tracking, using a newly developed real-time control and communication framework. Methods: The new KUKA LWR iiwa robot is used for robotized ultrasound real-time tumor tracking. Besides more precise probe contact pressure detection, this robot provides an additional 7th link, enhancing the dexterity of the kinematic and the mounted transducer. Several integrated, certified safety features create a safe environment for the patients during treatment. However, to remotely control the robot for the ultrasound application, a real-time control and communication framework has to be developed. Based on a client/server concept, client-side control commands are received and processed by a central server unit and are implemented by a client module running directly on the robot’s controller. Several special functionalities for robotized ultrasound applications are integrated and the robot can now be used for real-time control of the image quality by adjusting the transducer position, and contact pressure. The framework was evaluated looking at overall real-time capability for communication and processing of three different standard commands. Results: Due to inherent, certified safety modules, the new robot ensures a safe environment for patients during tumor tracking. Furthermore, the developed framework shows overall real-time capability with a maximum average latency of 3.6 ms (Minimum 2.5 ms; 5000 trials). Conclusion: The novel KUKA LBR iiwa robot will advance the current robotized ultrasound tracking system with important features. With the developed framework, it is now possible to remotely control this robot and use it for robotized ultrasound tracking applications, including image quality control and target tracking.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-G-JeP4-12: Real-Time Organ Motion Monitoring Using Ultrasound and KV Fluoroscopy During Lung SBRT Delivery

Purpose: Real-time ultrasound monitoring during SBRT is advantageous in understanding and identifying motion irregularities which may cause geometric misses. In this work, we propose to utilize real-time ultrasound to track the diaphragm in conjunction with periodical kV fluoroscopy to monitor motion of tumor or landmarks during SBRT delivery. Methods: Transabdominal Ultrasound (TAUS) b-mode images were collected from 10 healthy volunteers using the Clarity Autoscan System (Elekta). The autoscan transducer, which has a center frequency of 5 MHz, was utilized for the scans. The acquired images were contoured using the Clarity Automatic Fusion and Contouring workstation software. Monitoring sessions of 5 minute length were observed and recorded. The position correlation between tumor and diaphragm could be established with periodic kV fluoroscopy periodically acquired during treatment with Elekta XVI. We acquired data using a tissue mimicking ultrasound phantom with embedded spheres placed on a motion stand using ultrasound and kV Fluoroscopy. MIM software was utilized for image fusion. Correlation of diaphragm and target motion was also validated using 4D-MRI and 4D-CBCT. Results: The diaphragm was visualized as a hyperechoic region on the TAUS b-mode images. Volunteer set-up can be adjusted such that TAUS probe will not interfere with treatment beams. A segment of the diaphragm was contoured and selected as our tracking structure. Successful monitoring sessions of the diaphragm were recorded. For some volunteers, diaphragm motion over 2 times larger than the initial motion has been observed during tracking. For the phantom study, we were able to register the 2D kV Fluoroscopy with the US images for position comparison. Conclusion: We demonstrated the feasibility of tracking the diaphragm using real-time ultrasound. Real-time tracking can help in identifying such irregularities in the respiratory motion which is correlated to tumor motion. We also showed the feasibility of acquiring 2D KV Fluoroscopy and registering the images with Ultrasound.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2016

TH-A-207B-01: Basics and Current Implementations of Ultrasound Imaging of Shear Wave Speed and Elasticity

Imaging of tissue elastic properties is a relatively new and powerful approach to one of the oldest and most important diagnostic tools. Imaging of shear wave speed with ultrasound is has been added to most high-end ultrasound systems. Understanding this exciting imaging mode aiding its most effective use in medicine can be a rewarding effort for medical physicists and other medical imaging and treatment professionals. Assuring consistent, quantitative measurements across the many ultrasound systems in a typical imaging department will constitute a major step toward realizing the great potential of this technique and other quantitative imaging. This session will target these two goals with two presentations. A. Basics and Current Implementations of Ultrasound Imaging of Shear Wave Speed and Elasticity - Shigao Chen, Ph.D. Learning objectives-To understand: Introduction: Importance of tissue elasticity measurement Strain vs. shear wave elastography (SWE), beneficial features of SWE The link between shear wave speed and material properties, influence of viscosity Generation of shear waves External vibration (Fibroscan) ultrasound radiation force Point push Supersonic push (Aixplorer) Comb push (GE Logiq E9) Detection of shear waves Motion detection from pulse-echo ultrasound Importance of frame rate for shear wave imaging Plane wave imaging detection How to achieve high effective frame rate using line-by-line scanners Shear wave speed calculation Time to peak Random sample consensus (RANSAC) Cross correlation Sources of bias and variation in SWE Tissue viscosity Transducer compression or internal pressure of organ Reflection of shear waves at boundaries B. Elasticity Imaging System Biomarker Qualification and User Testing of Systems – Brian Garra, M.D. Learning objectives-To understand: Goals Review the need for quantitative medical imaging Provide examples of quantitative imaging biomarkers Acquaint the participant with the purpose of the RSNA Quantitative Imaging Biomarker Alliance and the need for such an organization Review the QIBA process for creating a quantitative biomarker Summarize steps needed to verify adherence of site, operators, and imaging systems to a QIBA profile Underlying Premise and Assumptions Objective, quantifiable results are needed to enhance the value of diagnostic imaging in clinical practice Reasons for quantification Evidence based medicine requires objective, not subjective observer data Computerized decision support tools (eg CAD) generally require quantitative input. Quantitative, reproducible measures are more easily used to develop personalized molecular medical diagnostic and treatment systems What is quantitative imaging? Definition from Imaging Metrology Workshop The Quantitative Imaging Biomarker Alliance Formation 2008 Mission Structure Example Imaging Biomarkers Being Explored Biomarker Selection Groundwork Draft Protocol for imaging and data evaluation QIBA Profile Drafting Equipment and Site Validation Technical Clinical Site and Equipment QA and Compliance Checking Ultrasound Elasticity Estimation Biomarker US Elasticity Estimation Background Current Status and Problems Biomarker Selection-process and outcome US SWS for Liver Fibrosis Biomarker Work Groundwork Literature search and analysis results Phase I phantom testing-Elastic phantoms Phase II phantom testing-Viscoelastic phantoms Digital Simulated Data Protocol and Profile Drafting Protocol: based on UPICT and existing literature and standards bodies protocols Profile-Current claims, Manufacturer specific appendices What comes after the profile Profile Validation Technical validation Clinical validation QA and Compliance Possible approaches Site Operator testing Site protocol re-evaluation Imaging system Manufacturer testing and attestation User acceptance testing and periodic QA Phantom Tests Digital Phantom Based Testing Standard QA Testing Remediation Schemes Profile Evolution Towards additional applications Towards higher accuracy and precision Supported in part by NIH contract HHSN268201300071C from NIBIB. Collaboration with GE Global Research, no personal support.; S. Chen, Some technologies described in this presentation have been licensed. Mayo Clinic and Dr. Chen have financial interests these technologies.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

TH-A-207B-02: QIBA Ultrasound Elasticity Imaging System Biomarker Qualification and User Testing of Systems

60 APPLIED LIFE SCIENCES↗