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1.  Color Doppler Imaging of Cardiac Catheters Using Vibrating Motors 
Ultrasonic imaging  2008;30(4):247-250.
We attached a miniature motor rotating at 11,000 rpm onto the proximal end of cardiac electrophysiological (EP) catheters in order to produce vibrations at the tip which were then visualized by color Doppler on ultrasound scanners. We imaged the catheter tip within a vascular graft submerged in a water tank using the Volumetrics Medical Imaging 3D scanner, the Siemens Sonoline Antares 2D scanner, and the Philips ie33 3D ultrasound scanner with TEE probe. The vibrating catheter tip was visualized in each case though results varied with the color Doppler properties of the individual scanner.
PMCID: PMC2804844  PMID: 19514134
Color flow Doppler; device guidance; cardiac electrophysiology catheters
2.  Transthoracic needle biopsy of thoracic tumours by a colour Doppler ultrasound puncture guiding device. 
Thorax  1995;50(12):1258-1263.
BACKGROUND--Ultrasound guided transthoracic needle aspiration biopsy has recently been used to obtain specimens for histological diagnosis of pulmonary and mediastinal tumours. Conventional real time, grey scale puncture guiding devices cannot differentiate vascular structures, and clear visualisation of the needle shaft or tip within a desired target is not always possible. This study describes a new built-in colour Doppler ultrasound puncture guiding device and assesses the relative safety of transthoracic needle aspiration biopsy of thoracic tumours by grey scale or colour Doppler ultrasound guidance. METHODS--Thirty patients with radiographic evidence of pulmonary (22 patients) or mediastinal tumours (eight patients) underwent ultrasonographic evaluation and transthoracic needle aspiration biopsy by using the colour Doppler ultrasound puncture guiding device (Aloka UST 5045P-3.5). These tumours were initially examined by grey scale ultrasound, and colour Doppler imaging was then used to evaluate the number of blood vessels surrounding and within the target tumour and the possibility of visualisation of the needle shaft or needle tip during the aspiration biopsy procedure. RESULTS--The colour Doppler ultrasound guiding device was far superior to the grey scale device for identification of the number of vessels surrounding or within the target tumour (83% v 20%) and for visualisation of the needle shaft or needle tip (80% v 17%). CONCLUSIONS--By using the colour Doppler ultrasound puncture device, vascular structures surrounding or within the target tumour can be verified. Visualisation of the needle shaft or tip is also better. Biopsy routes can be selected to avoid puncturing vessels. This approach should be particularly helpful for guiding biopsies of mediastinal tumours, where puncturing the heart or great vessels is a potential complication.
PMCID: PMC1021347  PMID: 8553297
3.  Accurate Guidance of a Catheter by Ultrasound Imaging and Identification of a Catheter Tip by Pulsed-Wave Doppler 
With the advent of numerous minimally invasive medical procedures, accurate catheter guidance has become imperative. We introduce and test an approach for catheter guidance by ultrasound imaging and pulsed-wave (PW) Doppler.
A steerable catheter is fitted with a small piezoelectric crystal at its tip that actively transmits signals driven by a function generator. We call this an active-tip (AT) catheter. In a water tank, we immersed a "target" crystal and a rectangular matrix of four “reference” crystals. 2D ultrasound imaging was used for initial guidance and visualization of the catheter shaft, and then PW Doppler mode was used to identify the AT catheter tip and guide it to the simulated target, which was also visible in the 2D ultrasound image. Ten guiding trials were performed from random initial positions of the AT catheter, each starting at approximately 8 cm from the target.
After the 10 navigational trials, the average final distance of the catheter tip from the target was 2.4 ± 1.2 mm, and the range of distances from the trials was from a minimum of 1.0 mm to a maximum of 4.5 mm.
Although early in the development process, these quantitative in vitro results show promise for catheter guidance with ultrasound imaging and tip identification by PW Doppler.
PMCID: PMC3899791  PMID: 22054263
ultrasound; catheter; acoustic; navigation; Doppler; pulsed-wave
4.  Doppler signals observed during high temperature thermal ablation are the result of boiling 
To elucidate the causation mechanism of Spectral Doppler ultrasound signals (DUS) observed during high temperature thermal ablation and evaluate their potential for image-guidance.
Sixteen ex vivo ablations were performed in fresh turkey breast muscle, eight with radiofrequency ablation (RFA) devices, and eight with a conductive interstitial thermal therapy (CITT) device. Temperature changes in the ablation zone were measured with thermocouples located at 1 to 10mm away from the ablation probes. Concomitantly, DUS were recorded using a standard diagnostic ultrasound scanner. Retrospectively, sustained observations of DUS were correlated with measured temperatures. Sustained DUS was arbitrarily defined as the Doppler signals lasting more than 10 s as observed in the diagnostic ultrasound videos captured from the scanner.
For RFA experiments, minimum average temperature (T1±SD) at which sustained DUS were observed was 97.2±7.3°C, while the maximum average temperature (T2±SD) at which DUS were not seen was 74.3±9.1°C. For CITT ablation, T1 and T2 were 95.7±5.9°C and 91.6±7.2°C, respectively. It was also observed, especially during CITT ablation, that temperatures remained relatively constant during Doppler activity.
The value of T1 was near the standard boiling point of water (99.61°C) while T2 was below it. Together, T1 and T2 support the conclusion that DUS during high temperature thermal ablation are the result of boiling (phase change). This conclusion is also supported by the nearly constant temperature histories maintained at locations from which DUS emanated.
PMCID: PMC2922477  PMID: 20569109
boiling; conductive interstitial thermal therapy; doppler ultrasound; radio frequency ablation; tissue water; vaporization
5.  Ultrasound Biomicroscopy in Small Animal Research: Applications in Molecular and Preclinical Imaging 
Ultrasound biomicroscopy (UBM) is a noninvasive multimodality technique that allows high-resolution imaging in mice. It is affordable, widely available, and portable. When it is coupled to Doppler ultrasound with color and power Doppler, it can be used to quantify blood flow and to image microcirculation as well as the response of tumor blood supply to cancer therapy. Target contrast ultrasound combines ultrasound with novel molecular targeted contrast agent to assess biological processes at molecular level. UBM is useful to investigate the growth and differentiation of tumors as well as to detect early molecular expression of cancer-related biomarkers in vivo and to monitor the effects of cancer therapies. It can be also used to visualize the embryological development of mice in uterus or to examine their cardiovascular development. The availability of real-time imaging of mice anatomy allows performing aspiration procedures under ultrasound guidance as well as the microinjection of cells, viruses, or other agents into precise locations. This paper will describe some basic principles of high-resolution imaging equipment, and the most important applications in molecular and preclinical imaging in small animal research.
PMCID: PMC3202139  PMID: 22163379
6.  Real-Time Magnetic Resonance Imaging–Guided Stenting of Aortic Coarctation With Commercially Available Catheter Devices in Swine 
Circulation  2005;112(5):699-706.
Real-time MR imaging (rtMRI) is now technically capable of guiding catheter-based cardiovascular interventions. Compared with x-ray, rtMRI offers superior tissue imaging in any orientation without ionizing radiation. Translation to clinical trials has awaited the availability of clinical-grade catheter devices that are both MRI visible and safe. We report a preclinical safety and feasibility study of rtMRI-guided stenting in a porcine model of aortic coarctation using only commercially available catheter devices.
Method and Results
Coarctation stenting was performed wholly under rtMRI guidance in 13 swine. rtMRI permitted procedure planning, device tracking, and accurate stent deployment. “Active” guidewires, incorporating MRI antennas, improved device visualization compared with unmodified “passive” nitinol guidewires and shortened procedure time (26±11 versus 106±42 minutes; P = 0.008). Follow-up catheterization and necropsy showed accurate stent deployment, durable gradient reduction, and appropriate neointimal formation. MRI immediately identified aortic rupture when oversized devices were tested.
This experience demonstrates preclinical safety and feasibility of rtMRI-guided aortic coarctation stenting using commercially available catheter devices. Patients may benefit from rtMRI in the future because of combined device and tissue imaging, freedom from ionizing radiation, and the ability to identify serious complications promptly.
PMCID: PMC1513629  PMID: 16043639
angioplasty; catheterization; coarctation; heart defects; congenital; stents
7.  Transabdominal Ultrasonography of the Small Bowel 
In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS) underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism), is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT) and magnetic resonance imaging (MRI) in small bowel examination.
PMCID: PMC3852808  PMID: 24348544
8.  High-intensity focused ultrasound ablation assisted using color Doppler imaging for the treatment of hepatocellular carcinomas 
Abdominal Imaging  2013;38:1263-1268.
We evaluated the usefulness of color Doppler flow imaging to compensate for the inadequate resolution of the ultrasound (US) monitoring during high-intensity focused ultrasound (HIFU) for the treatment of hepatocellular carcinoma (HCC).
Materials and methods
US-guided HIFU ablation assisted using color Doppler flow imaging was performed in 11 patients with small HCC (<3 lesions, <3 cm in diameter). The HIFU system (Chongqing Haifu Tech) was used under US guidance. Color Doppler sonographic studies were performed using an HIFU 6150S US imaging unit system and a 2.7-MHz electronic convex probe.
The color Doppler images were used because of the influence of multi-reflections and the emergence of hyperecho. In 1 of the 11 patients, multi-reflections were responsible for the poor visualization of the tumor. In 10 cases, the tumor was poorly visualized because of the emergence of a hyperecho. In these cases, the ability to identify the original tumor location on the monitor by referencing the color Doppler images of the portal vein and the hepatic vein was very useful. HIFU treatments were successfully performed in all 11 patients with the assistance of color Doppler imaging.
Color Doppler imaging is useful for the treatment of HCC using HIFU, compensating for the occasionally poor visualization provided by B-mode conventional US imaging.
PMCID: PMC3827892  PMID: 23728304
High-intensity focused ultrasound; Hepatocellular carcinoma; Ultrasound; Color Doppler imaging
9.  3-D Ultrasound Guidance of Autonomous Robot for Location of Ferrous Shrapnel 
Vibrations can be induced in ferromagnetic shrapnel by a variable electromagnet. Real time 3-D color Doppler ultrasound located the induced motion in a needle fragment and determined its 3-D position in the scanner coordinates. This information was used to guide a robot which moved a probe to touch the shrapnel fragment.
PMCID: PMC2810201  PMID: 19574140
10.  Current role of ultrasound for the management of hepatocellular carcinoma 
Hepatocellular carcinoma (HCC) has a decisive influence on the prognosis of cirrhotic patients. Although α-fetoprotein (AFP) is a known and specific tumor maker for HCC, it is not suitable for the screening and surveillance of HCC because of its poor predictive value and low sensitivity. The use of imaging modalities is essential for the screening, diagnosis and treatment of HCC. Ultrasound (US) plays a major role among them, because it provides real-time and non-invasive observation by a simple and easy technique. In addition, US-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of HCC. The development of digital technology has led to the detection of blood flow by color Doppler US, and the sensitivity for detecting tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents. Moreover, near real-time 3-dimensional US images are now available. As for the treatment of HCC, high intensity focused ultrasound (HIFU) was developed as a novel technology that provides a transcutaneous ablation effect without needle puncture. These advancements in the US field have led to rapid progress in HCC management, and continuing advances are expected. This article reviews the current application of US for HCC in clinical practice.
PMCID: PMC2695911  PMID: 18350602
Ultrasound; Contrast agent; Hepatocellular carcinoma; Liver; Surveillance; Treatments
11.  Technologies for Guidance of Radiofrequency Ablation in the Multimodality Interventional Suite of the Future 
Several new image-guidance tools and devices are being prototyped, investigated, and compared. These tools are introduced and include prototype software for image registration and fusion, thermal modeling, electromagnetic tracking, semiautomated robotic needle guidance, and multimodality imaging. The integration of treatment planning with computed tomography robot systems or electromagnetic needle-tip tracking allows for seamless, iterative, “see-and-treat,” patient-specific tumor ablation. Such automation, navigation, and visualization tools could eventually optimize radiofrequency ablation and other needle-based ablation procedures and decrease variability among operators, thus facilitating the translation of novel image-guided therapies. Much of this new technology is in use or will be available to the interventional radiologist in the near future, and this brief introduction will hopefully encourage research in this emerging area.
PMCID: PMC2555973  PMID: 17296700
12.  Real-time bulk-motion-correction free Doppler variance optical coherence tomography for choroidal capillary vasculature imaging 
Optics express  2011;19(4):3657-3666.
In this paper, we analyze the retinal and choroidal blood vasculature in the posterior segment of the human eye with optimized color Doppler and Doppler variance optical coherence tomography. Depth-resolved structure, color Doppler and Doppler variance images are compared. Blood vessels down to the capillary level were detected and visualized with the optimized optical coherence color Doppler and Doppler variance method. For in-vivo imaging of human eyes, bulk-motion induced bulk phase must be identified and removed before using the color Doppler method. It was found that the Doppler variance method is not sensitive to bulk-motion and the method can be used without correcting the bulk-motion when the sample-movement-induced velocity changes gradually. Real-time processing and displaying of the structure and blood vessel images are very interesting and is demonstrated using a dual quad-core Central Processing Unit (CPU) workstation. High resolution images of choroidal capillary of the vasculature network with phased-resolved color Doppler and Doppler variance are shown.
PMCID: PMC3110778  PMID: 21369191
13.  Real-time bulk-motion-correction free Doppler variance optical coherence tomography for choroidal capillary vasculature imaging 
Optics Express  2011;19(4):3657-3666.
In this paper, we analyze the retinal and choroidal blood vasculature in the posterior segment of the human eye with optimized color Doppler and Doppler variance optical coherence tomography. Depth-resolved structure, color Doppler and Doppler variance images are compared. Blood vessels down to the capillary level were detected and visualized with the optimized optical coherence color Doppler and Doppler variance method. For in-vivo imaging of human eyes, bulk-motion induced bulk phase must be identified and removed before using the color Doppler method. It was found that the Doppler variance method is not sensitive to bulk-motion and the method can be used without correcting the bulk-motion when the sample-movement-induced velocity changes gradually. Real-time processing and displaying of the structure and blood vessel images are very interesting and is demonstrated using a dual quad-core Central Processing Unit (CPU) workstation. High resolution images of choroidal capillary of the vasculature network with phased-resolved color Doppler and Doppler variance are shown.
PMCID: PMC3110778  PMID: 21369191
(170.4500) Optical coherence tomography; (170.3890) Medical optics instrumentation; (170.3340) Laser Doppler velocimetry
14.  Navigation with Electromagnetic Tracking for Interventional Radiology Procedures 
To assess the feasibility of the use of preprocedural imaging for guide wire, catheter, and needle navigation with electromagnetic tracking in phantom and animal models.
An image-guided intervention software system was developed based on open-source software components. Catheters, needles, and guide wires were constructed with small position and orientation sensors in the tips. A tetrahedral-shaped weak electromagnetic field generator was placed in proximity to an abdominal vascular phantom or three pigs on the angiography table. Preprocedural computed tomographic (CT) images of the phantom or pig were loaded into custom-developed tracking, registration, navigation, and rendering software. Devices were manipulated within the phantom or pig with guidance from the previously acquired CT scan and simultaneous real-time angiography. Navigation within positron emission tomography (PET) and magnetic resonance (MR) volumetric datasets was also performed. External and endovascular fiducials were used for registration in the phantom, and registration error and tracking error were estimated.
The CT scan position of the devices within phantoms and pigs was accurately determined during angiography and biopsy procedures, with manageable error for some applications. Preprocedural CT depicted the anatomy in the region of the devices with real-time position updating and minimal registration error and tracking error (<5 mm). PET can also be used with this system to guide percutaneous biopsies to the most metabolically active region of a tumor.
Previously acquired CT, MR, or PET data can be accurately codisplayed during procedures with reconstructed imaging based on the position and orientation of catheters, guide wires, or needles. Multimodality interventions are feasible by allowing the real-time updated display of previously acquired functional or morphologic imaging during angiography, biopsy, and ablation.
PMCID: PMC2375916  PMID: 15802449
15.  Ultrasound Guided Reduction of an Ileocolic Intussusception by a Hydrostatic Method by Using Normal Saline Enema in Paediatric Patients: A Study of 30 Cases 
The conventional hydrostatic reduction of an intussusception with barium enema or the pneumatic reduction of an intussusception is associated with considerable ionizing radiations and a risk of perforation; while the hydrostatic reduction of an intussusception under ultrasound guidance is a very safe method because the whole procedure is visualized with real time ultrasound. Also, being a non-invasive method with a high success rate, this procedure has emerged as a useful alternative to a surgical intervention.
The aim of this study was to evaluate the role of ultrasound and colour Doppler studies for the guidance of the hydrostatic reduction of a childhood intussusception by using normal saline.
Among 41 children who were evaluated with ultrasonography for the confirmation of the presence of intussusceptions, hydrostatic reduction of intussusception were performed under a sonographic guidance in 30 patients, whereas 11 patients were excluded due to clinical contraindications.
This disease was observed mostly at the ages of 6 months to 24 months. In 80% of the patients, there was a recent history of gastroenteritis and 40 % had a history of common cold. The most common site of the intussusception was the transverse colon near the hepatic flexor of the colon (90%), with a mean duration of 22.1±17.3 hours. The overall rate of a successful reduction was 87% and the mean reduction time was 14 minutes. None of the cases showed recurrence within 24 hrs. No complications were observed.
We conclude that ultrasound with colour Doppler study is very useful for the diagnosis of intussusceptions, as well as for guided hydrostatic reductions by using normal saline enema. This is an optimal, simple, and a safe procedure for the treatment of intussusceptions in paediatric patients.
PMCID: PMC3552213  PMID: 23373037
Ultrasound; Colour Doppler study; Intussusceptions; Hydrostatic reduction
16.  MRI-Guided Vascular Access with an Active Visualization Needle 
To develop an approach to vascular access under MRI, as a component of comprehensive MRI-guided cardiovascular catheterization and intervention.
Materials and Methods
We attempted jugular vein access in healthy pigs as a model of “difficult” vascular access. Procedures were performed under real-time MRI guidance using reduced field of view imaging. We developed an “active” MRI antenna-needle having an open-lumen, distinct tip appearance and indicators of depth and trajectory, in order to enhance MRI visibility during the procedure. We compared performance of the active needle against an unmodified commercial passively-visualized needle, measured by procedure success among operators with different levels of experience.
MRI-guided central vein access was feasible using both the active needle and the unmodified passive needle. The active needle required less time (88 vs. 244 sec, p=0.022) and fewer needle passes (4.5 vs. 9.1, p=0.028), irrespective of operator experience.
MRI-guided access to central veins is feasible in our animal model. When image guidance is necessary for vascular access, performing this component under MRI will allow wholly MRI-guided catheterization procedures that do not require adjunctive imaging facilities such as X-ray or ultrasound. The active needle design showed enhanced visibility, as expected. These capabilities may permit more complex catheter-based cardiovascular interventional procedures enabled by enhanced image guidance.
PMCID: PMC3201741  PMID: 22006552
Interventional MRI; Vascular access; Actively visualized devices
17.  Gynecological Surgery and Low Back Pain in Older Women 
Objective: To determine sacroiliac joint compliance characteristics and pelvic floor movements in older women relative to gynecological surgery history and back pain complaints. Design: Single-visit laboratory measurement. Setting: University clinical research center. Participants: Twenty-five women aged 65 years or older. Outcome Measures: Sacroiliac joint compliance measured by Doppler imaging of vibrations and ultrasound measures of pelvic floor motion during the active straight leg raise test. Results: Doppler imaging of vibrations demonstrated test reliability ranging from 0.701 to 0.898 for detecting vibration on the ilium and sacrum sides of the sacroiliac joint. The presence of low-back pain or prior gynecological surgery was not significantly associated with a difference in the compliance or laxity symmetry of the sacroiliac joints. No significant difference in pelvic floor movement was found during the active straight leg raise test between subject groups. All P values were ≥.4159. Conclusions: Prior gynecological surgery and low-back pain were not significantly associated with side-to-side differences in the compliance of the sacroiliac joints or in significant changes in pelvic floor movement during a loading maneuver in a group of older women.
PMCID: PMC3597293  PMID: 23569659
aging; back pain; gynecologic surgery; sacroiliac joint; pelvic floor; Doppler imaging of vibrations
18.  Evaluation of a novel, ultrathin, tip-bending endoscope in a synthetic force-sensing pancreas with comparison to medical guide wires 
Direct visualization of pancreatic ductal tissue is critical for early diagnosis of pancreatic diseases and for guiding therapeutic interventions. A novel, ultrathin (5 Fr) scanning fiber endoscope (SFE) with tip-bending capability has been developed specifically to achieve high resolution imaging as a pancreatoscope during endoscopic retrograde cholangiopancreatography (ERCP). This device has potential to dramatically improve both diagnostic and therapeutic capabilities during ERCP by providing direct video feedback and tool guidance to clinicians.
Invasiveness of the new tip-bending SFE was evaluated by a performance comparison to ERCP guide wires, which are routinely inserted into the pancreatic duct during ERCP. An in vitro test model with four force sensors embedded in a synthetic pancreas was designed to detect and compare the insertion forces for 0.89 mm and 0.53 mm diameter guide wires as well as the 1.7 mm diameter SFE. Insertions were performed through the working channel of a therapeutic duodenoscope for the two types of guide wires and using a statistically similar direct insertion method for comparison to the SFE.
Analysis of the forces detected by the sensors showed the smaller diameter 0.53 mm wire produced significantly less average and maximum forces during insertion than the larger diameter 0.89 mm wire. With the use of tip-bending and optical visualization, the 1.7 mm diameter SFE produced significantly less average force during insertion than the 0.89 mm wire at every sensor, despite its larger size. It was further shown that the use of tip-bending with the SFE significantly reduced the forces at all sensors, compared to insertions when tip-bending was not used.
Combining high quality video imaging with two-axis tip-bending allows a larger diameter guide wire-style device to be inserted into the pancreatic duct during ERCP with improved capacity to perform diagnostics and therapy.
PMCID: PMC3500967  PMID: 23166452
endoscopic retrograde cholangiopancreatography (ERCP); scanning fiber endoscope (SFE); pancreatic cancer; minimally invasive therapy
19.  New ultrasound techniques for lymph node evaluation 
Conventional ultrasound (US) is the recommended imaging method for lymph node (LN) diseases with the advantages of high resolution, real time evaluation and relative low costs. Current indications of transcutaneous ultrasound and endoscopic ultrasound include the detection and characterization of lymph nodes and the guidance for LN biopsy. Recent advances in US technology, such as contrast enhanced ultrasound (CEUS), contrast enhanced endoscopic ultrasound (CE-EUS), and real time elastography show potential to improve the accuracy of US for the differential diagnosis of benign and malignant lymph nodes. In addition, CEUS and CE-EUS have been also used for the guidance of fine needle aspiration and assessment of treatment response. Complementary to size criteria, CEUS could also be used to evaluate response of tumor angiogenesis to anti-angiogenic therapies. In this paper we review current literature regarding evaluation of lymphadenopathy by new and innovative US techniques.
PMCID: PMC3740414  PMID: 23946589
Lymph nodes; Ultrasound; Endoscopic ultrasound; Lymph node metastasis; Lymphoma
20.  Color-Doppler Ultrasound in the Diagnosis of Oral Vascular Anomalies 
In last few years, thanks to laser technology with minimally invasive approach, there was a growing need for treatment of oral vascular malformations inside the dental offices. Generally, the diagnosis of oral vascular malformations is based on clinical history, clinical examination and imaging exams. In the present paper, we review, researching by PubMed, the technical aspects, clinical indications, potentialities and limitations of color-Doppler ultrasound in the work-up of oral vascular malformations. Different imaging modalities are encountered for the diagnosis and follow-up of these lesions such as computed tomography, magnetic resonance imaging, color-Doppler ultrasound and angiography. To date, color-Doppler ultrasound is considered the first-line imaging approach since it provides a non-invasive, cost effective, real time evaluation of oral vascular anomalies. It provides both morphological and vascular information, which are useful to determine the best therapeutic options. Ultrasonography, for these reasons, could be considered as a valuable diagnostic tool in the preliminary assessment of oral vascular anomalies.
PMCID: PMC3938866  PMID: 24678469
Color-Doppler ultrasound; hemangiomas; oral cavity; vascular malformations
21.  Real-Time MRI Guided Atrial Septal Puncture and Balloon Septostomy in Swine 
Cardiac perforation during atrial septal puncture (ASP) might be avoided by improved image guidance. X-ray fluoroscopy (XRF), which guides ASP, visualizes tissue poorly and does not convey depth information. Ultrasound is limited by device shadows and constrained imaging windows. Alternatively, real-time MRI (rtMRI) provides excellent tissue contrast in any orientation and may enable ASP and balloon atrial septostomy (BAS) in swine.
Materials and Methods
Custom MRI catheters incorporated “active” (receiver antenna) and “passive” (iron or gadolinium) elements. Wholly rtMRI-guided transfemoral ASP and BAS were performed in 10 swine in a 1.5T interventional suite. Hemodynamic results were measured with catheters and velocity encoded MRI.
Successful ASP was performed in all 10 animals. Necropsy confirmed septostomy confined within the fossa ovalis in all. BAS was successful in 9/10 animals. Antenna failure in a re-used needle led to inadvertent vena cava tear prior to BAS in one animal. ASP in the same animal was easily performed using a new needle. rtMRI illustrated clear device-tissue-lumen relationships in multiple orientations, and facilitated simple ASP and BAS. The mean procedure time was 19 ± 10 minutes. Septostomy achieved a mean left to right shunt ratio of 1.3:1 in these healthy animals.
Interactive rtMRI permits rapid transcatheter ASP and BAS in swine. Further technical development may enable novel applications.
PMCID: PMC1463249  PMID: 16532499
22.  GPU Based Real-time Instrument Tracking with Three Dimensional Ultrasound 
Medical image analysis  2007;11(5):458-464.
Real-time three-dimensional ultrasound enables new intra-cardiac surgical procedures, but the distorted appearance of instruments in ultrasound poses a challenge to surgeons. This paper presents a detection technique that identifies the position of the instrument within the ultrasound volume. The algorithm uses a form of the generalized Radon transform to search for long straight objects in the ultrasound image, a feature characteristic of instruments and not found in cardiac tissue. When combined with passive markers placed on the instrument shaft, the full position and orientation of the instrument is found in 3D space. This detection technique is amenable to rapid execution on the current generation of personal computer graphics processor units (GPU). Our GPU implementation detected a surgical instrument in 31 ms, sufficient for real-time tracking at the 25 volumes per second rate of the ultrasound machine. A water tank experiment found instrument orientation errors of 1.1 degrees and tip position errors of less than 1.8 mm. Finally, an in vivo study demonstrated successful instrument tracking inside a beating porcine heart.
PMCID: PMC2693901  PMID: 17681483
23.  Real-Time 3-D Ultrasound Guidance of Interventional Devices 
We have previously developed 2-D array transducers for many real-time volumetric imaging applications. These applications include transducers operating up to 7 MHz for transthoracic imaging, up to 15 MHz for intracardiac echocardiography (ICE), 5 MHz for transesophageal echocardiography (TEE) and intracranial imaging, and 7 MHz for laparoscopic ultrasound imaging (LUS). Now we have developed a new generation of miniature ring-array transducers integrated into the catheter deployment kits of interventional devices to enable real-time 3-D ultrasound scanning for improved guidance of minimally invasive procedures. We have constructed 3 new ring transducers. The first consists of 54 elements operating at 5 MHz. Typical measured transducer element bandwidth was 25%, and the 50 Ohm round trip insertion loss was −65 dB. Average nearest neighbor cross talk was −23.8 dB. The second is a prototype 108-element transducer operating at 5 MHz. The third is a prototype 108-element ring array with a transducer center frequency of 8.9 MHz and a −6 dB bandwidth of 25%. All transducers were integrated with an 8.5 French catheter sheath of a Cook Medical, Inc. vena cava filter deployment device.
PMCID: PMC2656286  PMID: 18986903
24.  Shear Wave Velocity Imaging Using Transient Electrode Perturbation: Phantom and ex vivo Validation 
This paper presents a new shear wave velocity imaging technique to monitor radio-frequency and microwave ablation procedures, coined electrode vibration elastography. A piezoelectric actuator attached to an ablation needle is transiently vibrated to generate shear waves that are tracked at high frame rates. The time-to-peak algorithm is used to reconstruct the shear wave velocity and thereby the shear modulus variations. The feasibility of electrode vibration elastography is demonstrated using finite element models and ultrasound simulations, tissue-mimicking phantoms simulating fully (phantom 1) and partially ablated (phantom 2) regions, and an ex vivo bovine liver ablation experiment. In phantom experiments, good boundary delineation was observed. Shear wave velocity estimates were within 7% of mechanical measurements in phantom 1 and within 17% in phantom 2. Good boundary delineation was also demonstrated in the ex vivo experiment. The shear wave velocity estimates inside the ablated region were higher than mechanical testing estimates, but estimates in the untreated tissue were within 20% of mechanical measurements. A comparison of electrode vibration elastography and electrode displacement elastography showed the complementary information that they can provide. Electrode vibration elastography shows promise as an imaging modality that provides ablation boundary delineation and quantitative information during ablation procedures.
PMCID: PMC3066053  PMID: 21075719
Electrode vibration elastography; radio-frequency (RF) ablation; shear wave tracking; time-to-peak; ultrasound
25.  Ultrasonic locating devices for central venous cannulation: meta-analysis 
BMJ : British Medical Journal  2003;327(7411):361.
Objectives To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation.
Data sources 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature.
Design Systematic review and meta-analysis of randomised controlled trials.
Populations Patients scheduled for central venous access.
Intervention reviewed Guidance using real time two dimensional ultrasonography or Doppler needles and probes compared with the anatomical landmark method of cannulation.
Data extraction Risk of failed catheter placement (primary outcome), risk of complications from placement, risk of failure on first attempt at placement, number of attempts to successful catheterisation, and time (seconds) to successful catheterisation.
Data synthesis 18 trials (1646 participants) were identified. Compared with the landmark method, real time two dimensional ultrasound guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall (relative risk 0.14, 95% confidence interval 0.06 to 0.33) and on the first attempt (0.59, 0.39 to 0.88). Limited evidence favoured two dimensional ultrasound guidance for subclavian vein and femoral vein procedures in adults (0.14, 0.04 to 0.57 and 0.29, 0.07 to 1.21, respectively). Three studies in infants confirmed a higher success rate with two dimensional ultrasonography for internal jugular procedures (0.15, 0.03 to 0.64). Doppler guided cannulation of the internal jugular vein in adults was more successful than the landmark method (0.39, 0.17 to 0.92), but the landmark method was more successful for subclavian vein procedures (1.48, 1.03 to 2.14). No significant difference was found between these techniques for cannulation of the internal jugular vein in infants. An indirect comparison of relative risks suggested that two dimensional ultrasonography would be more successful than Doppler guidance for subclavian vein procedures in adults (0.09, 0.02 to 0.38).
Conclusions Evidence supports the use of two dimensional ultrasonography for central venous cannulation.
PMCID: PMC175809  PMID: 12919984

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