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Biomedical subjects

J C Bamber

Publications and source records attributed to J C Bamber.

At least 37 records · Page 2Linked to original sources

Breast carcinoma: measurement of tumor response to primary medical therapy with color Doppler flow imaging.

PURPOSE: To assess the ability of color Doppler flow imaging to help evaluate the response of breast cancer to medical therapy. MATERIALS AND METHODS: Thirty-four patients with large or centrally located breast carcinomas were studied. All tumors had been treated medically. Tumor size was assessed at clinical examination, volume at B-mode ultrasound (US), and vascularity at color Doppler flow imaging. The changes seen during the treatment course were cross compared and correlated with final tumor response. RESULTS: In 97 of the 126 treatment cycles (77%), changes in vascularity were concordant with changes in the size of the tumors (reduction in the vascularity with response to therapy and an increase in tumor size with lack of response or progression). Changes seen at color Doppler flow imaging occurred at least 4 weeks before those seen at clinical and B-mode US examination in 40% and 38% of cases, respectively. Changes in vascularity could be assessed in every patient. CONCLUSION: Color Doppler flow imaging can help assessed and predict the response of breast cancer to medical treatment.

Antineoplastic Combined Chemotherapy Protocols↗

Acoustic properties of lesions generated with an ultrasound therapy system.

Methods for quantitative imaging of ultrasound propagation properties were applied to the examination of the acoustic appearance of lesions generated by high intensity focused ultrasound in excised pig livers. Single lesions, about 10 mm maximum diameter by 30 mm long, were created in each of six liver specimens. Two dimensional images (32 by 32 points) of sound speed, mean attenuation coefficient (as a function of frequency in the range 3 to 8.5 MHz) and mean backscattering coefficient (5 to 8 MHz) were obtained in 7 mm thick sections of tissue, cut to include a cross-section through the lesion. Images of these properties, presented alongside surface photographs of the samples, provided a qualitative demonstration that attenuation coefficient was the most useful and backscattering coefficient was the least useful acoustic parameter for visualizing such lesions. Quantitatively the data demonstrated significant increases in attenuation coefficient and sound speed in lesioned liver relative to normal, whereas backscattering was shown not to change in a significant manner except when undissolved gas is the mechanism for increased acoustic scattering. Samples where gas was not fully removed following lesion production gave significant increases in backscattering at the lesion centre, but the shape and size of regions of high backscattering coefficient corresponded poorly with the shape and size of the lesions, unlike attenuation and sound speed for which such correspondence was good.

Acoustics↗

Compensation for the signal processing characteristics of ultrasound B-mode scanners in adaptive speckle reduction.

A systematic method to compensate for nonlinear amplification of individual ultrasound B-scanners has been investigated in order to optimise performance of an adaptive speckle reduction (ASR) filter for a wide range of clinical ultrasonic imaging equipment. Three potential methods have been investigated: (1) a method involving an appropriate selection of the speckle recognition feature was successful when the scanner signal processing executes simple logarithmic compressions; (2) an inverse transform (decompression) of the B-mode image was effective in correcting for the measured characteristics of image data compression when the algorithm was implemented in full floating point arithmetic; (3) characterising the behaviour of the statistical speckle recognition feature under conditions of speckle noise was found to be the method of choice for implementation of the adaptive speckle reduction algorithm in limited precision integer arithmetic. In this example, the statistical features of variance and mean were investigated. The third method may be implemented on commercially available fast image processing hardware and is also better suited for transfer into dedicated hardware to facilitate real-time adaptive speckle reduction. A systematic method is described for obtaining ASR calibration data from B-mode images of a speckle producing phantom.

Algorithms↗

High frequency, high resolution B-scan ultrasound in the assessment of skin tumours.

Sixteen skin tumours and one BCG vaccination granuloma were examined by 20-MHz B-scan ultrasound. Images were compared with closely matched histological sections of excised lesions. The correlation between histology and ultrasound was excellent for maximum tumour depth measurements (r = 0.96, P < 0.0001), but less good for maximum width (r = 0.84, P < 0.0001) because of the elastic contraction of tissue at excision. Architectural detail of lesions on histological sections corresponded well with that on ultrasound images. There was a good correlation for heterogeneity (collagen distribution vs. echo pattern (r = 0.86, P < 0.0001)), and between collagen content and echogenicity of lesions (r = 0.69, P < 0.003). Strong correlations were also obtained for echogenicity vs. spacing of collagen bundles (r = -0.65, P < 0.005), echogenicity vs. collagen bundle size (r = 0.58, P < 0.02), and echogenicity vs. cellularity (r = -0.68, P < 0.003). Results for dermatofibroma were atypical, due to paradoxical low internal echogenicity and increased echo absorption. B-scanning is a reliable non-invasive method for assessing tumour dimensions, and has potential for the study of tumour characteristics for diagnostic purposes.

Adult↗

Breast diseases: color Doppler US in differential diagnosis.

PURPOSE: To subjectively and semiquantitatively evaluate color Doppler signals on images of breast lesions. MATERIALS AND METHODS: A 5-MHz ultrasound (US) system was used to examine 210 new breast lesions. Signals were evaluated subjectively with an analog scale. A semiquantitative scoring system involved analysis of the average number of vessels per square centimeter and average density of color pixels. RESULTS: Vessels were detected in 57 of 58 cancers (mean, 0.11 vessels per square centimeter, occupying 1.76% of the scan area). Color Doppler scores had no correlation with conventional prognostic indicators such as lymph node status or survival. Fewer vessels per square centimeter (mean, 0.06) occupying a smaller area (mean, 0.41%) were detected in the five fibroadenomas (n = 36) that showed color Doppler signals. Most cases (99 of 104 [96%]) of benign breast changes had no color Doppler signals. CONCLUSION: Color Doppler signals in a lesion otherwise thought to be benign should prompt a biopsy, while the absence of signals in an indeterminate lesion is reassuring.

Adenofibroma↗

Visual impact of adaptive speckle reduction on US B-mode images.

Adaptive speckle reduction, which is designed to improve image contrast, dramatically alters the familiar appearance of the ultrasonographic B-mode scan. The acceptability to radiologists of this alternative method of display was assessed. Four experienced radiologists selected B-mode scans from 83 liver and 71 breast examinations and graded the change in diagnostically important features after adaptive speckle reduction. There was no loss of important anatomic detail in the smoothed images and a net reduction in image artifacts. Removal of speckle noise improved definition of lesion margins in 38.3% of cases and enhanced visibility of metastases in 35.4% of liver studies and 7.7% of breast lesions. In 42.1% of cases, the textural information in the image was judged to be enhanced. Image information in general was said to be better seen in 49.5% of cases. The preliminary radiologic experience with speckle-reduced B-mode echograms is favorable and does not indicate generation of any substantial image artifacts.

Breast Neoplasms↗

Real-time implementation of coherent speckle suppression in B-scan images.

Early experiences of new forms of adaptive filtering for ultrasound speckle reduction and parametric imaging, using off-line conventional digital processing, have been sufficiently encouraging to warrant examining the feasibility of implementing specific algorithms in real-time. A hardware two-dimensional real-time filter is described which consists of a hybrid digital/analogues system in which the video signal from any scanner is sampled to 256 points per line and passed sequentially through a series of shift registers, in order to derive a 5 x 5 window of values which surrounds the image point currently being processed. These 25 video signals are then used as inputs to an analogue processor, which provides the filtered output. The real-time processed images show clear evidence of speckle smoothing without blurring of tissue structural information but possess limited pixel resolution.

Filtration↗

What might echography learn from image science?

We review the current state of knowledge of the processes by which the information content of ultrasonic pulse-echo images is transferred to an observer, to the point of contributing to diagnostic judgments. As systematic knowledge in this specific field is rather sparse, we present relevant information and techniques derived from other areas of image science, both medical and otherwise. Quantitative measures both of the information content of ultrasonic and other images and of their characteristic noise content are first considered. An account is then given of the relevant aspects of human visual psychophysics, with particular reference to perception of contrast and detail, image texture, movement and colour, again with emphasis on documenting quantitative aspects of such behaviour. Against this background, we consider the efficiency, in current practice, of image information transfer to a human observer, how and to what extent this could be improved by changes in practice and, in particular, in what situations substantial innovations in machine processing of image data would be expected to improve human performance. It is suggested that several problems in the field may provide a worthwhile and challenging scope for future research.

Humans↗

A new coaxial needle for pre-operative localization of breast abnormalities.

A new coaxial needle, containing a retractable anchoring wire with a helical tip, has been developed for purposes of mammographic and sonographic localization of non-palpable suspicious breast abnormalities before surgical excision. The helically shaped tip provides the needle with a number of potential advantages over other currently available localization needles. During in vitro comparisons with other needles quantitative and qualitative evidence was obtained to suggest that the new needle can be expected to have improved anchoring capability, be deflected less by tough fibrous tissue interfaces and be more visible sonographically. The anchoring wire can also be retracted and repositioned. Preliminary clinical experience with the needle was consistent with these expectations.

Animals↗

Performance criteria for quantitative ultrasonography and image parameterisation.

For the purpose of assessing and comparing the practical performance of various specific approaches to quantitative tissue characterisation, three sets of performance criteria are proposed, relating respectively to contrast resolution, spatial resolution, and speed of presentation. In each case numerical performance targets are suggested: in particular that spatial resolution should preferably be within a linear factor of three of the best achievable anatomical resolution of the associated imaging techniques and that presentation speed should be 'real time' (i.e. about 10 Hz). In the light of these criteria and performance targets the main existing approaches to ultrasonic tissue characterisation are then considered. These are classified in two groups: first those approaches based on measurements of bulk properties of tissues and secondly those related to parameters of the structural organisation of tissues. Examination of available evidence suggests that the latter group are more promising than the former. Finally it is argued that ultrasonic methods of tissue characterisation have substantial practical potential but that the realisation of such potential is contingent on achieving consensus on choice of a single, optimised and generally applicable approach that would carry with it the linked benefits of industrial standardisation and broad sharing of clinical experience.

Humans↗

Color Doppler signals from breast tumors. Work in progress.

The color Doppler signals in 60 patients with breast masses were assessed subjectively, and a regional grading method was developed for quantitation of displayed blood vessel density. Among 21 patients with breast carcinoma, moderate or high flow was demonstrated in all but one, with an average of 0.5 vessels per square centimeter and color pixels occupying 12.2% of the image area. Among 33 patients with benign disorders, no flow was demonstrated in 25 and slight to moderate flow was seen in five, with an average of 0.01 vessels per square centimeter, occupying 0.8% of the image area. Cancers as small as 10 mm in diameter were positive for flow. High-velocity flow was seen only in malignancies; it was observed in four cases and may have been due to arteriovenous shunting. Flow was less readily detected in recurrent tumors; two of seven tumors were weakly positive. Color Doppler shows promise as an adjunct to ultrasound imaging in the differential diagnosis of breast lesions.

Blood Vessels↗

Quantitative effects of speckle reduction on cross sectional echocardiographic images.

Speckle is prominent on all cross sectional echocardiograms. In order to assess its effects on image quantification, frames from a sector scanner with a six bit grey scale were stored and processed off line to identify and smooth the speckle by means of an adaptive filter based on fully developed speckle. In 14 controls, 12 patients with hypertrophic cardiomyopathy, and 12 with secondary left ventricular hypertrophy, filtering significantly reduced the standard deviation of echo intensity, which was used as a measure of the scatter of pixel amplitude, in all three groups (by 52%, 46%, and 46% respectively). The mean value of back-scattered echo intensity itself, however, was reduced by only 7%, 5%, and 8% respectively, and median values were not affected at all. Mean (SD) left ventricular cavity areas on the apical four chamber view were significantly increased from 26 (15) to 30 (17) cm2. The valve dimensions in the parasternal minor axis in 10 patients with mitral stenosis were significantly increased by 11% laterally, but were unaffected anteroposteriorly. Subjective image quality was appreciably modified: endocardial boundaries in apical views were enhanced and the septal "ground glass" appearance was lost in hypertrophic cardiomyopathy. Speckle reduction therefore greatly reduced the scatter of pixel values, with little effect on the mean regional back scattered echo amplitude. It also modified the perceived image texture. Improved boundary definition consistently increased the area estimates, particularly when these depended on lateral rather than range resolution.

Cardiomegaly↗

Application of Fourier analysis to clinical study of patterns of tissue movement.

An analysis is made of the kinetics of human liver parenchyma in response to mechanical impulses arising in the heart and aorta, and the results are applied to predicting the time course of the correlation between two time-separated A-scans derived from various regions of the liver. Such predictions are found to correspond well with data derived clinically, both from volunteers and from patients with liver metastases, using a commercial, real-time sector scanner. On the basis of Fourier spectral features of the clinically derived correlation patterns, a clear quantitative separation was demonstrated between the kinetic response of three classes of tissue: normal liver in volunteers, metastatic deposits in liver of cancer patients, and histologically normal liver regions in the same patients.

Elasticity↗

Quantitative evaluation of real-time ultrasound features of the breast.

Semi-quantitative diagnostic features were extracted by a visual analysis of the echographic images of selected cases of breast disease and the results stored in a computer database. The long term aim is to create an environment suitable for the use of multivariate statistical methods systematically to evaluate ultrasound interpretive criteria and diagnostic performance in relation to factors such as scanning instrumentation and other diagnostic techniques. Eventually it is hoped that it will be possible to generate a system for computer assisted diagnosis and training. The results of this pilot study serve to demonstrate the feasibility of the approach and a univariate analysis is used to provide a preliminary ranking of diagnostic features. Features found to be particularly valuable for distinguishing benign from malignant solid lesions were the regularity and definition of the edge of the tumour, the mobility of the tumour and measures of echo heterogeneity within and posterior to the tumour mass.

Breast↗

Ultrasonic Doppler study of the hormonal response of blood flow in the normal human breast.

The breasts of seven normal female volunteers were examined using a continuous wave, directional 10 MHz ultrasonic Doppler system. A range of quantitative features were extracted from recorded Doppler signals by first computing an average, single cardiac cycle sonogram from 4-6 overlayed cardiac cycles of sonogram data taken from each recording. Substantial variations were observed to occur in both frequency and amplitude characteristics of the Doppler signals during the menstrual cycle and pregnancy. For each subject the two breasts behaved similarly and the fluctuations correlated with known variations in blood hormone levels and breast surface temperature. In the one case of pregnancy, the mammary blood flow appeared to increase throughout pregnancy, beginning very shortly after conception. It is concluded that the normal fluctuations of the blood flow in the breast may make a large contribution to the variance of Doppler-derived blood flow features for the pre-menopausal breast. Use of the contralateral breast as a control is advocated for studies of the application of the Doppler method to the diagnosis and measurement of therapeutic response of breast cancer in young women. The usefulness of the contralateral breast as such a control might be enhanced by performing Doppler examinations only at about the midcycle. If the presence of a tumour were to alter these fluctuations there may be a possibility of using the effect to advantage alongside other methods for early diagnosis of breast cancer.

Breast↗

Adaptive filtering for reduction of speckle in ultrasonic pulse-echo images.

Current medical ultrasonic scanning instrumentation permits the display of fine image detail (speckle) which does not transfer useful information but degrades the apparent low contrast resolution in the image. An adaptive two-dimensional filter has been developed which uses local features of image texture to recognize and maximally low-pass filter those parts of the image which correspond to fully developed speckle, while substantially preserving information associated with resolved-object structure. A first implementation of the filter is described which uses the ratio of the local variance and the local mean as the speckle recognition feature. Preliminary results of applying this form of display processing to medical ultrasound images are very encouraging; it appears that the visual perception of features such as small discrete structures, subtle fluctuations in mean echo level and changes in image texture may be enhanced relative to that for unprocessed images.

Humans↗