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Many clinicians regard speckle noise as an undesirable artifact in ultrasound images masking the underlying pathology within a patient. Speckle noise is a random interference pattern formed by coherent radiation in a medium containing many sub-resolution scatterers. Speckle has a negative impact on ultrasound images as the texture does not reflect the local echogenicity of the underlying scatterers. Studies have shown that the presence of speckle noise can reduce a physician's ability to detect lesions by a factor of eight. Without speckle, small high-contrast targets, low contrast objects, and image texture can be deduced quite readily. <br /><br /> Speckle filtering of medical ultrasound images represents a critical pre-processing step, providing clinicians with enhanced diagnostic ability. Efficient speckle noise removal algorithms may also find applications in real time surgical guidance assemblies. However, it is vital that regions of interests are not compromised during speckle removal. This research pertains to the reduction of speckle noise in ultrasound images while attempting to retain clinical regions of interest. <br /><br /> Recently, the advance of wavelet theory has lead to many applications in noise reduction and compression. Upon investigation of these two divergent fields, it was found that the speckle noise tends to rotate an image's homomorphic complex-wavelet coefficients. This work proposes a new speckle reduction filter involving a counter-rotation of these complex-wavelet coefficients to mitigate the presence of speckle noise. Simulations suggest the proposed denoising technique offers superior visual quality, though its signal-to-mean-square-error ratio (S/MSE) is numerically comparable to adaptive frost and kuan filtering. <br /><br /> This research improves the quality of ultrasound medical images, leading to improved diagnosis for one of the most popular and cost effective imaging modalities used in clinical medicine.

The early detection of prostate cancer plays a significant role in the success of treatment and outcome. To detect prostate cancer, imaging modalities such as TransRectal UltraSound (TRUS) and Magnetic Resonance Imaging (MRI) are relied on. MRI images are more comprehensible than TRUS images which are corrupted by noise such as speckles and shadowing. However, MRI screening is costly, often unavailable in many community hospitals, time consuming, and requires more patient preparation time. Therefore, TRUS is more popular for screening and biopsy guidance for prostate cancer. For these reasons, TRUS images are chosen in this research. Radiologists first segment the prostate image from ultrasound image and then identify the hypoechoic regions which are more likely to exhibit cancer and should be considered for biopsy. In this thesis, the focus is on prostate segmentation and on Regions of Interest (ROI)segmentation. First, the extraneous tissues surrounding the prostate gland are eliminated. Consequently, the process of detecting the cancerous regions is focused on the prostate gland only. Thus, the diagnosing process is significantly shortened. Also, segmentation techniques such as thresholding, region growing, classification, clustering, Markov random field models, artificial neural networks (ANNs), atlas-guided, and deformable models are investigated. In this dissertation, the deformable model technique is selected because it is capable of segmenting difficult images such as ultrasound images. Deformable models are classified as either parametric or geometric deformable models. For the prostate segmentation, one of the parametric deformable models, Gradient Vector Flow (GVF) deformable contour, is adopted because it is capable of segmenting the prostate gland, even if the initial contour is not close to the prostate boundary. The manual segmentation of ultrasound images not only consumes much time and effort, but also leads to operator-dependent results. Therefore, a fully automatic prostate segmentation algorithm is proposed based on knowledge-based rules. The new algorithm results are evaluated with respect to their manual outlining by using distance-based and area-based metrics. Also, the novel technique is compared with two well-known semi-automatic algorithms to illustrate its superiority. With hypothesis testing, the proposed algorithm is statistically superior to the other two algorithms. The newly developed algorithm is operator-independent and capable of accurately segmenting a prostate gland with any shape and orientation from the ultrasound image. The focus of the second part of the research is to locate the regions which are more prone to cancer. Although the parametric dynamic contour technique can readily segment a single region, it is not conducive for segmenting multiple regions, as required in the regions of interest (ROI) segmentation part. Since the number of regions is not known beforehand, the problem is stated as 3D one by using level set approach to handle the topology changes such as splitting and merging the contours. For the proposed ROI segmentation algorithm, one of the geometric deformable models, active contours without edges, is used. This technique is capable of segmenting the regions with either weak edges, or even, no edges at all. The results of the proposed ROI segmentation algorithm are compared with those of the two experts' manual marking. The results are also compared with the common regions manually marked by both experts and with the total regions marked by either expert. The proposed ROI segmentation algorithm is also evaluated by using region-based and pixel-based strategies. The evaluation results indicate that the proposed algorithm produces similar results to those of the experts' manual markings, but with the added advantages of being fast and reliable. This novel algorithm also detects some regions that have been missed by one expert but confirmed by the other. In conclusion, the two newly devised algorithms can assist experts in segmenting the prostate image and detecting the suspicious abnormal regions that should be considered for biopsy. This leads to the reduction the number of biopsies, early detection of the diseased regions, proper management, and possible reduction of death related to prostate cancer.

Conventional ultrasonographic examination of the bovine ovary is based on a sequence of two-dimensional (2D) cross-section images. Day-to-day estimation of the number, size, shape and position of the ovarian follicles is one of the most important aspects of ovarian research. Computer-assisted follicle segmentation of ovarian volume can relieve physicians from the tedious manual detection of follicles, provide objective assessment of spatial relationships between the ovarian structures and therefore has the potential to improve accuracy. Modern segmentation procedures are performed on 2D images and the three-dimensional (3D) visualization of follicles is obtained from the reconstruction of a sequence of 2D segmented follicles. <p>The objective of this study was to develop a semi-automatic 3D follicle segmentation method based on seeded region growing. The 3D datasets were acquired from a sequence of 2D ultrasound images and the ovarian structures were segmented from the reconstructed ovarian volume in a single step. A seed is placed manually in each follicle and the growth of the seed is controlled by the algorithm using a combination of average grey-level, standard deviation of the intensity, newly-developed volumetric comparison test and a termination criterion. One important contribution of this algorithm is that it overcomes the boundary leakage problem of follicles of conventional 2D segmentation procedures. The results were validated against the aspiration volume of follicles, the manually detected follicles by an expert and an existing algorithm.<p>We anticipate that this algorithm will enhance follicular assessment based on current ultrasound techniques in cases when large numbers of follicles (e.g. ovarian superstimulation) obviate accurate counting and size measurement.

Syftet med studien är att undersöka hur en population av potentiellt blivande föräldrar i åldrarna 20-40 år önskar att handläggning av informationen kring ultraljudsmarkörer bör se ut. Studien utformades som en pilotstudie med bekvämlighetsurval, och en enkät med parametrar fördelade på 11 scenarion utarbetades. Enkäten delades ut på föreläsningar i och omkring Stockholm i april 2012. 49 kvinnor och 36 män deltog i undersökningen. Potentiellt blivande föräldrar vill ofta få information om upptäckta softmarkers. Dock svarar en betydande del av försökspersonerna att de för vissa scenarion inte vill ta del av all tillgänglig information. Flest vill ha information vid obotliga tillstånd och när markören sitter i fostrets hjärna eller hjärta. De scenarion där flest svarar att de inte vill bli informerade är då markören sitter i fostrets tarm eller skelett samt när tillståndet är bortbart. Signifikanta skillnader uppmättes mellan olika gruppers svar. Kvinnor svarar oftare än män att de inte vill ha information om funna softmarkers. Detsamma gäller för sambos/gifta när man jämför dem med de som är singlar. De som hade barn vill oftare inte veta om att en softmarker har upptäckts jämfört med de som inte har barn. / The aim of the study was to investigate how potential new parents aged 20-40 would prefer the information about soft markers to be handled. The study was designed as a pilot study, and a questionnaire was made with parameters divided into 11 scenarios. The questionnaire was handed out at lectures in the Stockholm area in April of 2012. Answers were analyzed in SPSS with chi-2 tests. 49 women and 36 men participated in the study. Potential new parents often wish to be informed of discovered soft markers. However, a significant portion of the participants say they prefer not to know about soft markers in their foetus in some scenarios. Scenarios where the condition is incurable or where the soft marker is placed in the brain or heart of the foetus are the ones where the most people say they want the information. A soft marker placed in the foetus’ intestines or skeleton is when the most people answer that they do not wish to recieve this information. Significant differences are seen between different groups. Women more often than men say they do not want information about a discovered soft marker. The same is true for those who are married or cohabitating when compared to singles. Those who are already parents want information about a soft marker to a lower degree than those who do not have children.

<p>Phase correction has the potential to increase the image quality of real-time 3D (RT3D) ultrasound, especially for transcranial ultrasound. Such improvement would increase the diagnostic utility of transcranial ultrasound, leading to improvements in stroke diagnosis, treatment, and monitoring. This work describes the implementation of the multi-lag least-squares cross-correlation and partial array speckle brightness methods for static and moving targets and the investigation of contrast-enhanced (CE) RT3D transcranial ultrasound.</p><p>The feasibility of using phase aberration correction with 2D arrays and RT3D ultrasound was investigated. Using the multi-lag cross-correlation method on electronic and physical aberrators, we showed the ability of 3D phase aberration correction to increase anechoic cyst identification, image brightness, contrast-to-noise ratio (CNR), and, in 3D color Doppler experiments, the ability to visualize flow. With a physical aberrator, CNR increased by 13%, while the number of detectable cysts increased from 4.3 to 7.7.</p><p>We performed an institutional review board (IRB) approved clinical trial to assess the ability of a novel ultrasound technique, namely RT3D CE transcranial ultrasound. Using micro-bubble contrast agent, we scanned 17 healthy volunteers via a single temporal window and 9 via the sub-occipital window and report our detection rates for the major cerebral vessels. In 82% of subjects, we identified the ipsilateral circle of Willis from the temporal window, and in 65% we imaged the entire circle of Willis. From the sub-occipital window, we detected the entire vertebrobasilar circulation in 22% of subjects, and in 50% the basilar artery. </p><p>We then compared the performance of the multi-lag cross-correlation method with partial array reference on static and moving targets for an electronic aberrator. After showing that the multi-lag method performs better, we evaluated its performance with a physical aberrator. Using static targets, the correction resulted in an average contrast increase of 22.2%, compared to 13.2% using moving targets. The CNR increased by 20.5% and 12.8%, respectively. Doppler signal strength and number of Doppler voxels increased, by 5.6% and 14.4%, respectively, for the static method, and 9.3% and 4.9% for moving targets. </p><p>We performed two successful in vivo aberration corrections. We used this data and measure the isoplanatic patch size to be an average of 10.1°. The number of Doppler voxels increased by 38.6% and 19.2% for the two corrections. In both volunteers, correction enabled the visualization of a vessel not present in the uncorrected volume. These results are promising, and could potentially have a significant impact on public health.</p><p>Lastly, we show preliminary work testing the feasibility of a unique portable dedicated transcranial ultrasound system capable of simultaneous scanning from all three acoustic windows. Such a system would ideally be used in a preclinical setting, such as an ambulance.</p> / Dissertation

<p>Each year, over 13,000 people in the United States die from a primary malignant brain tumor. Currently, primary BTs are treated most commonly by surgery, radiotherapy, and systemic chemotherapy, though each of these methods carries a risk of complications or acute side effects.</p><p>Ultrasound hyperthermia has been investigated as way to open the blood-brain barrier for improved chemotherapeutic drug delivery, but previous methods have involved either invasively removing skull bone via surgery or non-invasively dealing with the high ultrasound attenuation, reflection, and phase aberration resulting from the skull and its variable thickness. Dual-mode ultrasound transducers for image-guided therapy have also been investigated for several applications; in some instances, phased arrays are ideal, allowing control over the ultrasound energy deposition pattern and inherent spatial registration between imaging, treatment, and monitoring.</p><p>Additionally, thermosensitive liposomes can be configured to encapsulate drugs and actively target regions of tumor angiogenesis. When used in combination with localized hyperthermia, thermosensitive liposomes can provide targeted control of drug release that may enhance chemotherapeutic efficacy in many clinical settings. Meanwhile, catheter devices and endovascular techniques are used by interventional neuroradiologists to treat various intracranial diseases, including intracranial aneurysm and dural venous sinus thrombosis. These procedures can be extended to the treatment of intracranial tumors (advancement of a 5 Fr catheter as far as the frontal portion of the superior sagittal sinus has been demonstrated).</p><p>The objective of the work presented in this dissertation was the realization of a dual-mode catheter transducer for a minimally-invasive, vascular approach to deliver localized, image-guided ultrasound hyperthermia to an intracranial tumor target. Toward this end, a series of prototype ultrasound transducers were designed, simulated, built, and tested for imaging and therapeutic potential.</p><p>Two 14-Fr phased-array prototypes were built with PZT-5H ceramic and tested for real-time 3D intracranial imaging and focused-beam hyperthermia capability. These were able to visualize the lateral ventricles and Circle of Willis in a canine model, and generate a temperature rise over 4&deg;C at a 2-cm focal distance in excised tissue.</p><p>Single-channel intravascular ultrasound (IVUS) coronary imaging catheters as small as 3.5 Fr were then considered as a construction template; several possible transducer apertures were simulated before fabricating prototypes with PZT-4. The transducers exhibited a dual-frequency response, due to the presence of thickness-mode and width-mode resonances. A thermal model was developed to estimate the +4&deg;C thermal penetration depth for a given transducer aperture, predicting an effective therapeutic range of up to 12 mm with a 5 × 0.5 mm aperture.</p><p>A 3.5-Fr commercial mechanical IVUS catheter was retrofitted with a PZT-4 transducer and tested for 9-MHz imaging performance in several animal studies, successfully visualizing anatomical structures in the brain and navigating a minimally-invasive vascular pathway toward the brain. An identical PZT-4 transducer was used to build a 3.3-MHz therapy prototype, which produced a temperature rise of +13.5&deg;C at a depth of 1.5 mm in live xenograft brain tumor tissue in the mouse model.</p><p>These studies indicate that a minimally-invasive catheter transducer can be made capable of visualizing brain structures and generating localized hyperthermia to trigger drug release from thermosensitive liposomes in brain tumor tissue.</p> / Dissertation

<p>Piezoelectric micromachined ultrasound transducer (pMUT) two-dimensional (2D) arrays have been proposed as an alternative to conventional bulk-PZT thickness-mode transducers for high frequency, forward-looking, catheter-based ultrasound imaging of the cardiovascular system. The appeal of pMUTs is based on several key advantages over conventional transducer technologies, including high operational frequencies, small element size, and low cost due to their microelectromechanical system (MEMS) silicon-based fabrication. While previous studies have demonstrated acoustic performance characteristics suitable for ultrasound image formation, pulse-echo B-mode imaging of tissue and tissue-like phantoms using 2D pMUT arrays small enough for forward-looking catheter-based applications have been demonstrated only at Duke University by Dausch et al.</p><p>Having demonstrated the suitability of 2D pMUT arrays for tissue imaging, an important step is to demonstrate effective design control. The frequency of operation is a fundamental component of transducer design. Previous modeling efforts for pMUT vibration have used classical/Kirchoff thin plate theory (CPT) or Mindlin thick plate theory, however pMUTs with geometric dimensions similar to those explored here, have not been modeled with experimental comparison to physical devices.</p><p>It is hypothesized that the frequency of vibration of pMUTs can be predictively modeled based on experimental data from various pMUT configurations. Experimental frequency results were acquired and used to develop an empirical model based on a modified Mindlin thick plate theory. This dissertation presents the development of the frequency design theory culminating in a set of predictive design equations for the frequency of vibration of 2D pMUT arrays aimed at improving their use in high-frequency, forward-looking, catheter-based ultrasound imaging applications.</p> / Dissertation

<p>Several groups have proposed classifying atherosclerotic disease by using acoustic radiation</p><p>force (ARF) elasticity methods to estimate the mechanical and material</p><p>properties of plaque. However, recent evidence suggests that cardiovascular disease</p><p>(CVD), in addition to involving pathological changes in arterial tissue, is also a</p><p>hemodynamic remodeling problem. As a result, integrating techniques that can</p><p>estimate localized hemodynamics relevant to CVD remodeling with existing ARF based</p><p>elastography methods may provide a more complete assessment of CVD.</p><p>This thesis describes novel imaging approaches for combining clinically-accepted,</p><p>ultrasound-based flow velocity estimation techniques (color-flow Doppler and spectral-</p><p>Doppler imaging) with ARF-based elasticity characterization of vascular tissue. Techniques</p><p>for integrating B-mode, color-flow Doppler, and ARFI imaging were developed</p><p>(BACD imaging), validated in tissue-mimicking phantoms, and demonstrated for in</p><p>vivo imaging. The resulting system allows for the real-time acquisition (< 20 Hz) of</p><p>spatially registered B-mode, flow-velocity, and ARFI displacement images of arterial</p><p>tissue throughout the cardiac cycle. ARFI and color-flow Doppler imaging quality,</p><p>transducer surface heating, and tissue heating were quantified for different frame-rate</p><p>and scan-duration configurations. The results suggest that BACD images can be acquired</p><p>at high frame rates with minimal loss of imaging quality for approximately</p><p>five seconds, while staying beneath suggested limits for tissue and transducer surface</p><p>heating.</p><p>Because plaque-burden is potentially a 3D problem, techniques were developed</p><p>to allow for the 3D acquisition of color-flow Doppler and ARFI displacement data</p><p>using a stage-controlled, freehand scanning approach. The results suggest that a</p><p>40mm x 20mm x 25mm BACD volume can be acquired in approximately three seconds.</p><p>Jitter, SNR, lesion CNR, soft-plaque detectability, and flow-area assessment were</p><p>quantified in tissue mimicking phantoms with a range of elastic moduli relevant</p><p>to ARFI imaging applications. Results suggest that both jitter and SNR degrade</p><p>with increased sweep velocity, and that degradation is worse when imaging stiffer</p><p>materials. The results also suggest that a transition between shearing-dominated</p><p>jitter and motion-dominated jitter occurs sooner with faster sweep speeds and in</p><p>stiffer materials. These artifacts can be reduced with simple, linear filters. Results</p><p>from plaque mimicking phantoms suggest that the estimation of soft-plaque area</p><p>and flow area, both important tasks for CVD imaging, are only minimally affected</p><p>at faster sweep velocities.</p><p>Current clinical assessment of CVD is guided by spectral Doppler velocity methods.</p><p>As a result, novel imaging approaches (SAD-SWEI, SAD-GATED) were developed</p><p>for combining spectral Doppler methods with existing ARF-based imaging</p><p>techniques to allow for the combined assessment of cross-luminal velocity profiles,</p><p>wall-shear rate (WSR), ARFI displacement and ARF-induced wave velocities. These</p><p>techniques were validated in controlled phantom experiments, and show good agreement</p><p>between previously described ARF-techniques and theory. Initial in vivo feasibility</p><p>was then evaluated in five human volunteers. Results show that a cyclic</p><p>variability in both ARFI displacement and ARF-generated wave velocity occurs during</p><p>the cardiac cycle. Estimates of WSR and peak velocity show good agreement</p><p>with previous ultrasonic-based assessments of these metrics. In vivo ARFI and Bmode/</p><p>WSR images of the carotid vasculature were successfully formed using ECG gating</p><p>techniques.</p><p>This thesis demonstrates the potential of these methods for the combined assessment</p><p>of vascular hemodynamics and elasticity. However, continued investigation</p><p>into optimizing sequences to reduce transducer surface heating, removing the angle</p><p>dependency of the SAD-SWEI/SAD-GATED methods, and decreasing processing</p><p>time will help improve the clinical viability of the proposed imaging techniques.</p> / Dissertation

<p>Clutter is a problematic noise artifact in a variety of ultrasound applications. Clinical tasks complicated by the presence of clutter include detecting cancerous lesions in abdominal organs (e.g. livers, bladders) and visualizing endocardial borders to assess cardiovascular health. In this dissertation, an analytical expression for contrast loss due to clutter is derived, clutter is quantified in abdominal images, and sources of abdominal clutter are identified. Novel clutter reduction methods are also presented and tested in abdominal and cardiac images. </p><p>One of the novel clutter reduction methods is Short-Lag Spatial Coherence (SLSC) imaging. Instead of applying a conventional delay-and-sum beamformer to measure the amplitude of received echoes and form B-mode images, the spatial coherence of received echoes are measured to form SLSC images. The world's first SLSC images of simulated, phantom, and <italic>in vivo</italic> data are presented herein. They demonstrate reduced clutter and improved contrast, contrast-to-noise, and signal-to-noise ratios compared to conventional B-mode images. In addition, the resolution characteristics of SLSC images are quantified and compared to resolution in B-mode images. </p><p>A clinical study with 14 volunteers was conducted to demonstrate that SLSC imaging offers 19-33% improvement in the visualization of endocardial borders when the quality of B-mode images formed from the same echo data was poor. There were no statistically significant improvements in endocardial border visualization with SLSC imaging when the quality of matched B-mode images was medium to good.</p> / Dissertation