Measurement of volume flow with time domain and M-mode imaging: in vitro and in vivo validation studies.

Color velocity imaging quantification is a commercially available technique that estimates volume flow within vessels by combining velocity data, acquired by time domain correlation, with vessel diameter measurements obtained by M-mode imaging. By integrating the velocity profile over time, quantitative volume flow calculations may be made. To investigate the accuracy of this system, we used two flow phantoms over a range of steady and pulsatile flows for in vitro evaluation, and the common carotid artery of 10 women on five consecutive occasions was insonated for in vivo assessment. In flow phantom studies, accuracy was within 8% for flows above 200 ml/min, but decreased at lower flows depending on the depth, beam-vessel angle used, and steering of the beam. At angles greater than 70 degrees, velocity errors made quantitative measurement of flow unreliable, whereas at angles less than 30 degrees, the increased error in calculating vessel diameter led to large errors of area estimation, and hence made flow measurements unreliable. For the in vivo studies on the carotid artery the intraoperator repeatability values for the three operators were 9.92% (A), 13.74% (B), and 13.24% (C). The interoperator repeatability for the group was 15.30%. This study suggests that the color velocity imaging quantification technique is an accurate and reproducible method of assessing volume flow in vessels. However, in our experience, obtaining volume flow data is more time consuming and operator dependent than traditional Doppler techniques. The color velocity imaging quantification system may be of use in monitoring conditions in which changes in volume flow in a vessel or to an organ is an important part of the disease process.     

Angle-dependence and reproducibility of dual-beam vector doppler ultrasound in the common carotid arteries of normal volunteers

Dual-beam vector Doppler has the potential to improve peak systolic blood velocity measurement accuracy by automatically correcting for the beam-flow Doppler angle. Using a modified linear-array system with a split receive aperture, we have assessed the angle-dependence over Doppler angles of 40 degrees -70 degrees and the reproducibility of the dual-beam blood maximum velocity estimate measured in the common carotid arteries (CCA) 1 to 2 cm prior to the bifurcation of 9 presumed-healthy volunteers. The velocity magnitude estimate was reduced by approximately 7.9% as the angle between the transmit beam and the vessel axis was increased from 40 degrees to 70 degrees. With repeat measurements made, on average, approximately 6 weeks apart, the 95% velocity magnitude limits of agreement were as follows: Intraobserver -41.3 to +45.2 cm/s; interobserver -29.6 to +46.8 cm/s. There was an 8.6 cm/s interobserver bias in velocity magnitude. We conclude that the dual-beam vector Doppler system can measure blood velocity within its scan plane with low dependence on angle and with similar reproducibility to that of single-beam systems.     

An investigation of simulated umbilical artery Doppler waveforms. I. The effect of three physical parameters on the maximum frequency envelope and on pulsatility index

The effect of three physical parameters on the accuracy of estimation of the maximum frequency envelope and pulsatility index (PI) of simulated umbilical artery Doppler waveforms was investigated. The physical parameters were beam-vessel angle, the offset between the beam axis and vessel axis, and the thickness of overlying attenuating material. Waveforms were acquired using a physiological flow phantom. The maximum frequency envelope was calculated using a threshold maximum frequency follower which was adaptive to the level of background noise. A gold standard maximum frequency envelope was obtained from the ensemble averaged waveform when there was alignment of beam and vessel axis, a 50 degrees beam-vessel angle and 2 cm of attenuating material. Indices of bias, variability and accuracy of estimation of the maximum frequency envelope and PI were calculated by comparing subsequent maximum frequency envelopes with the gold standard maximum frequency envelope. Both the maximum frequency envelope and PI were estimated to a similar degree of accuracy over a wide range of physical conditions. In this study, the error in PI was less than 0.15 for beam-vessel angles less than 80 degrees, for beam-vessel axis offset distances less than 7.5 mm, at a transducer-vessel distance of 5 cm, and for attenuator thicknesses less than 4.5 cm. The percentage root-mean square error for estimation of the maximum frequency envelope was approximately 10% or less for beam-vessel angles less than 75 degrees, for beam-vessel axis offset distances less than 7.5 mm, and for attenuator thicknesses less than 4 cm.     

An improved spectral width Doppler method for estimating Doppler angles in flows with existence of velocity gradients

Doppler angle (i.e., beam-to-flow angle) is an important parameter for quantitative flow measurements. With known Doppler angles, volumetric flows can be obtained by the mean flow velocity times the cross-section area of the vessel. The differences or changes between prestenotic and poststenotic volumetric flows have been quantified as an indicator for assessing the clinical severity of the stenosis. Therefore, several research groups have dedicated themselves to developing user-independent methods to determine automatically the Doppler angle. Nevertheless, most of these methods were developed for narrow ultrasound beam measurements. For small vessels, where the beam width is a significant fraction of the diameter of the vessel, the effect of velocity gradients plays an important role and should not be ignored in the Doppler angle estimations. Accordingly, this paper is concerned with a method for improving the estimation of Doppler angles from spectral width Doppler (SWD) method, but correcting for velocity-gradient broadening that may arise when the beam has a nonzero width. In our method, Doppler angles were firstly calculated by SWD and then were corrected by an artificial neural network (ANN) method to neutralize the contribution of velocity gradient broadening (VGB). This SWD and ANN conjoint method has been successfully applied to estimate Doppler angles from 50 degrees to 80 degrees for constant flows in 10 mm, 4 mm and 1 mm diameter tubes, whose mean flow velocities were 15.3, 19.9 and 25.5 cm/s, respectively, and the achieved mean absolute errors of the estimated Doppler angles were 1.46 degrees , 1.01 degrees and 1.3 degrees.     

Ultrasound Imaging Velocimetry: Effect of Beam Sweeping on Velocity Estimation

As an emerging flow-mapping tool that can penetrate deep into optically opaque media such as human tissue, ultrasound imaging velocimetry has promise in various clinical applications. Previous studies have shown that errors occur in velocity estimation, but the causes have not been well characterised. In this study, the error in velocity estimation resulting from ultrasound beam sweeping in image acquisition is quantitatively investigated. The effects on velocity estimation of the speed and direction of beam sweeping relative to those of the flow are studied through simulation and experiment. The results indicate that a relative error in velocity estimation of up to 20% can be expected. Correction methods to reduce the errors under steady flow conditions are proposed and evaluated. Errors in flow estimation under unsteady flow are discussed.     

Implementation of spectral width Doppler in pulsatile flow measurements

In this paper, we present an automatic beam-vector (Doppler) angle and flow velocity measurement method and implement it in pulsatile flow measurements using a clinical Doppler ultrasound system. In current clinical Doppler ultrasound flow velocity measurements, the axis of the blood vessel needs to be set manually on the B-scan image to enable the estimation of the beam-vector angle and the beam-vector angle corrected flow velocity (the actual flow velocity). In this study, an annular array transducer was used to generate a conical-shaped and symmetrically focused ultrasound beam to measure the flow velocity vectors parallel and perpendicular to the ultrasound beam axis. The beam-vector angle and flow velocity is calculated from the mode frequency (f(d)) and the maximum Doppler frequency (f(max)) of the Doppler spectrum. We develop a spectrum normalization algorithm to enable the Doppler spectrum averaging using the spectra obtained within a single cardiac cycle. The Doppler spectrum averaging process reduces the noise level in the Doppler spectrum and also enables the calculation of the beam-vector angle and flow velocity for pulsatile flows to be measured. We have verified the measurement method in vivo over a wide range of angles, from 52 degrees to 80 degrees, and the standard deviations of the measured beam-vector angles and flow velocities in the carotid artery are lower than 2.2 degrees and 12 cm/s (about 13.3%), respectively.     

Reduction of coherent scattering noise with multiple receiver Doppler

Doppler ultrasound (US) velocity estimates are inherently subject to error as a result of both Doppler ambiguity and coherent scattering. The coherent scattering error is a result of changes in the phase of the returned echo as particles enter and leave the sample volume. This phase depends on the distance from the transmitter to the scatterer and then to the receiver. This distance, in turn, depends on the angle of the receiver. A numerical simulation has been used to determine whether velocity estimates obtained from receiver probes at different angles are independent of one another. If so, then it is possible to obtain an improved velocity estimate from the combination of several receivers at different angles. The simulation results show that the cross-correlation between velocity estimates is reduced to 0.3 when receiver probes are oriented 5 degrees apart. These results suggest a new Doppler method that can significantly reduce velocity estimation error.     

Doppler angle estimation of pulsatile flows using AR modeling

In quantitative ultrasonic flow measurements, the beam-to-flow angle (i.e., Doppler angle) is an important parameter. An autoregressive (AR) spectral analysis technique in combination with the Doppler spectrum broadening effect was previously proposed to estimate the Doppler angle. Since only a limited number of flow samples are used, real-time two-dimensional Doppler angle estimation is possible. The method was validated for laminar flows with constant velocities. In clinical applications, the flow pulsation needs to be considered. For pulsatile flows, the flow velocity is time-varying and the accuracy of Doppler angle estimation may be affected. In this paper, the AR method using only a limited number of flow samples was applied to Doppler angle estimation of pulsatile flows. The flow samples were properly selected to derive the AR coefficients and then more samples were extrapolated based on the AR model. The proposed method was verified by both simulations and in vitro experiments. A wide range of Doppler angles (from 3o degrees to 78 degrees) and different flow rates were considered. The experimental data for the Doppler angle showed that the AR method using eight flow samples had an average estimation error of 3.50 degrees compared to an average error of 7.08 degrees for the Fast Fourier Transform (FFT) method using 64 flow samples. Results indicated that the AR method not only provided accurate Doppler angle estimates, but also outperformed the conventional FFT method in pulsatile flows. This is because the short data acquisition time is less affected by the temporal velocity changes. It is concluded that real-time two-dimensional estimation of the Doppler angle is possible using the AR method in the presence of pulsatile flows. In addition, Doppler angle estimation with turbulent flows is also discussed. Results show that both the AR and FFT methods are not adequate due to the spectral broadening effects from the turbulence.     

An Automatic Angle Tracking Procedure for Feasible Vector Doppler Blood Velocity Measurements

Two-dimensional angle-independent blood velocity estimates typically combine the Doppler frequencies independently measured by two ultrasound beams with known interbeam angle. A different dual-beam approach was recently introduced in which one (reference) beam is used to identify the flow direction, and the second (measuring) beam directly estimates the true flow velocity at known beam-flow angle. In this paper, we present a procedure to automatically steer the two beams along optimal orientations so that the velocity magnitude can be measured. The operator only takes care of locating the Doppler sample volume in the region of interest and, through the extraction of appropriate parameters from the Doppler spectrum, the reference beam is automatically steered toward right orientation to the flow. The velocity magnitude is thus estimated by the measuring beam, which is automatically oriented with respect to the (known) flow direction at a suitable Doppler angle. The implementation of the new angle tracking method in the ULtrasound Advanced Open Platform (ULA-OP), connected to a linear array transducer, is reported. A series of experiments shows that the proposed method rapidly locks the flow direction and measures the velocity magnitude with low variability for a large range of initial probe orientations. In vitro tests conducted in both steady and pulsatile flow conditions produced coefficients of variability (CV) below 2.3% and 8.3%, respectively. The peak systolic velocities have also been measured in the common carotid arteries of 13 volunteers, with mean CV of 7%. (E-mail: piero.tortoli@unifi.it).     

Investigation of Ultrasound-Measured Flow Velocity,Flow Rate and Wall Shear Rate in Radial and Ulnar Arteries Using Simulation

Parameters of blood flow measured by ultrasound in radial and ulnar arteries, such as flow velocity, flow rate and wall shear rate, are widely used in clinical practice and clinical research. Investigation of these measurements is useful for evaluating accuracy and providing knowledge of error sources. A method for simulating the spectral Doppler ultrasound measurement process was developed with computational fluid dynamics providing flow-field data. Specific scanning factors were adjusted to investigate their influence on estimation of the maximum velocity waveform, and flow rate and wall shear rate were derived using the Womersley equation. The overestimation in maximum velocity increases greatly (peak systolic from about 10% to 30%, time-averaged from about 30% to 50%) when the beam–vessel angle is changed from 30° to 70°. The Womersley equation was able to estimate flow rate in both arteries with less than 3% error, but performed better in the radial artery (2.3% overestimation) than the ulnar artery (15.4% underestimation) in estimating wall shear rate. It is concluded that measurements of flow parameters in the radial and ulnar arteries with clinical ultrasound scanners are prone to clinically significant errors.     

Sources of error in maximum velocity estimation using linear phased-array Doppler systems with steady flow

Using linear-array Doppler ultrasound (US) transducers, the measured maximum velocity may be in error and lead to incorrect clinical diagnosis. This study investigates the existence and cause of maximum velocity estimation errors for steady flow of a blood-mimicking fluid in a tissue-mimicking phantom. A specially designed system was used that enabled fine control of flow rate, transducer positioning and transducer angle relative to the flow phantom. Doppler machine settings (transducer aperture size, focal depth, beam-steering, gain) were varied to investigate a wide range of clinical applications. To estimate the maximum velocity, a new signal-to-noise ratio (SNR) independent method was developed to calculate the maximum frequency from an ensemble averaged Doppler power spectrum. This enabled the impact of each factor on the total Doppler error to be determined. When using the new maximum frequency estimator, it was found that the effect of transducer focal depth, intratransducer, intramachine, intermachine (that was tested) and beam-steering did not significantly contribute to maximum velocity estimation errors. Instead, it was the dependence of the maximum velocity on the Doppler angle that made, by far, the greatest contribution to the estimation error. Because our maximum frequency estimator took into account the effect of intrinsic spectral broadening, the degree of overestimation error was not as great as that previously published. Thus, the effects of Doppler angle and intrinsic spectral broadening are the chief sources of Doppler US error and should be the focus of future efforts to improve the accuracy.     

Examples of in vivo blood vector velocity estimation

In this paper, a case study of in-vivo blood vector velocity images of the carotid artery are presented. The transverse oscillation (TO) method for blood vector velocity estimation has been used to estimate the vector velocities. The carotid arteries of three healthy volunteers are scanned in-vivo at three different positions by experienced sonographers. The scanning regions are: 1) the common carotid artery at 88 degrees beam to flow angle, 2) the common carotid artery and the jugular vein at approximately 90 degrees beam to flow angle and 3) the bifurcation of the carotid artery. The resulting velocity estimates are displayed as vector velocity images, where the velocity vector is superimposed on a B-mode image showing the tissue structures. The volume flow is found for case 1) and when compared with MRI from the literature, a bias of approximately approximately 20% is found. The maximum flow velocity within the carotid artery is found to be 0.8 m/s, which is normal for a healthy person. In case 3), the estimated vector velocities are compared with numerical simulations. Qualitatively similar flow pattern can be seen in both simulations and in the vector velocity images. Furthermore, a vortex is identified in the carotid sinus at the deceleration phase after the peak systole. This vortex is seen in all of the three acquired cardiac cycles.     

Comparison of conventional and transverse Doppler sonograms

When measuring flow velocity using the conventional ultrasonic Doppler effect, beam axis-to-flow angles approaching 90 degrees are avoided as the Doppler spectrum frequency shift is known to go to zero at this angle. In this paper, the conventional Doppler technique is compared with the transverse Doppler method, in which the Doppler spectrum bandwidth is used to estimate flow, allowing flow to be probed at 90 degrees. The comparison is made using a moving thread flow phantom capable of executing various velocity profiles. This technique may allow the probing of vessels that are inaccessible to conventional oblique probing, thus complementing the conventional Doppler technique.     

Vector Doppler imaging of a spinning disc ultrasound Doppler phantom

Vector Doppler methods are used to obtain angle independent in-plane velocity information. Velocity magnitude as well as direction are reconstructed from regular steered colour flow and from split-aperture Doppler acquisitions. Spatially resolved in-plane velocity was obtained through Doppler colour flow mode and subsequent data triangulation. A depth-invariant constant Doppler angle was achieved by using a depth expanding transmit-receive Doppler aperture. Velocities of up to 50 cm s(-1) and 360 degrees vector velocity directions were measured. This was achieved by creating a spinning solid disc phantom. Such a phantom was built to allow underwater mounting and spinning of a solid disc-shaped ultrasound phantom (maximum velocity of 50 cm s-1). Doppler triangulation was realised by steered Doppler and by a split-aperture approach. Results of both imaging methods are shown. Split-aperture results showed errors of less then 10% for velocity magnitude estimation and less then 2.5 degrees for directional information.     

The impact of theoretical errors on velocity estimation and accuracy of duplex grading of carotid stenosis

Two potential errors in velocity estimation, Doppler angle misalignment and intrinsic spectral broadening (ISB), were determined and used to correct recorded blood velocities obtained from 20 patients (38 bifurcations). The recorded and corrected velocities were used to grade stenoses of greater than 70% using two duplex classification schemes. The first scheme used a peak systolic velocity (PSV) of > 250 cm/s in the internal carotid artery (ICA), and the second a PSV ratio of > 3.4 (ICA PSV/common carotid artery PSV). The "gold standard" was digital subtraction angiography (DSA). The maximum error in velocity estimation due to Doppler angle misalignment was 33 cm/s, but this did not alter sensitivity of stenosis detection. ISB correction caused a reduction in PSV that decreased the sensitivity of the PSV scheme from 65% to 45%. The PSV ratio classification was not affected by ISB errors. Centres using a PSV criterion for grading stenosis should use a fixed Doppler angle and should establish velocity thresholds in-house.     

An Angular Compounding Technique Using Displacement Projection for Noninvasive Ultrasound Strain Imaging of Vessel Cross-Sections

Strain is considered to be a useful indicator of atherosclerotic plaque vulnerability. This study introduces an alternative for a recently introduced strain imaging method that combined beam steered ultrasound acquisitions to construct radial strain images of transverse cross-sections of superficial arteries. In that study, axial strains were projected in the radial direction. Using the alternative method introduced in this study, axial displacements are projected radially, followed by a least squares estimation of radial strains. This enables the use of a larger projection angle. Consequently, fewer acquisitions at smaller beam steering angles are required to construct radial strain images. Simulated and experimentally obtained radio-frequency data of radially expanding vessel phantoms were used to compare the two methods. Using only three beam steering angles (–30°, 0° and 30°), the new method outperformed the older method that used seven different angles and up to 45° of beam steering: the root mean squared error was reduced by 38% and the elastographic signal- and contrast-to-noise ratios increased by 1.8 dB and 4.9 dB, respectively. The new method was also superior for homogeneous and heterogeneous phantoms with eccentric lumens. To conclude, an improved noninvasive method was developed for radial strain imaging in transverse cross-sections of superficial arteries. (E-mail: r.hansen@cukz.umcn.nl)     

Performance analysis of the Flutter VRP1 under different flows and angles

BACKGROUND: The Flutter VRP1 device is used for airway clearance. Its performance is based on 4 basic effects: positive expiratory pressure (PEP), forced exhalations (huff), high-frequency airway flow oscillation, and modification of mucus viscoelasticity. The purpose of this study was to determine the flow and angle conditions in which these effects are optimized. METHODS: In an experimental setting, a Flutter VRP1 was fixed at angles of -30 degrees , -15 degrees , 0 degrees , +15 degrees , and +30 degrees , and submitted to flows ranging from 0.2 L/s to 2.0 L/s. The flows and angles that resulted in higher and lower values of mean pressure, mean flow, oscillation frequency, and flow amplitude were determined. In addition, it was defined which angles facilitated achieving "ideal" mean pressure of 10 cm H2O and 20 cm H2O and oscillation frequency of 12 Hz. RESULTS: At all flows, +15 degrees produced higher mean pressure (p < 0.01), whereas lower values were produced at -30 degrees at lower flows, 0 degrees at intermediate flows, and +30 degrees at higher flows (p < 0.01). Higher oscillation frequencies were produced at +30 degrees and +15 degrees (p < 0.01), and lower values were produced at -30 degrees and -15 degrees at all flows (p < 0.01). Higher flow-amplitude values were produced at +30 degrees , +15 degrees , and 0 degrees (p < 0.01), and lower values were produced at -30 degrees and -15 degrees (p < 0.01). Mean pressure of 10 cm H2O was reached with the lowest flow (0.2 L/s) at +30 degrees , and mean pressure of 20 cm H2O was produced at +15 degrees (1.0 L/s), whereas an oscillation frequency of 12 Hz was reached at 0 degrees , +30 degrees , and +15 degrees , at 0.2 L/s. CONCLUSIONS: Positive inclinations optimize positive expiratory pressure and flow-amplitude effects, whereas negative inclinations optimize huff effect. This theoretical knowledge may help optimize the use of the device when applied to different conditions.     

Correction of refraction and other angle errors in beam tracking speed of sound estimations using multiple tracking transducers

The beam tracking approach to the estimation of the speed of sound has shown potential for making unbiased estimates in tissues. The speed of sound in a medium can be found from the arrival times of echoes as a function of the position of a tracking transducer. There is a problem in this approach if the angle between the direction of tracked beam and the direction of tracking translation is not zero due to refraction or other effects. An angle error as small as 1 degree would result in an error that is too large for diagnostic applications. A modified technique using three or more tracking transducers is described. This yields a corrected speed of sound estimate, and calculates the angle error. A simulation program has shown that this modified technique could indeed correct for the angle errors.     

Normal values for left anterior descending coronary artery flow velocity assessed by transthoracic doppler echocardiography in healthy children

Normal values for left anterior descending coronary artery (LAD) flow velocity were assessed from a large number of normal children. In 303 healthy children, LAD peak flow velocity was measured by Doppler echocardiography. LAD peak flow velocities were calculated considering the angle between the Doppler beam and the coronary flow direction. The flow signals of LAD were recorded in 95% (288/303). The mean angle between the Doppler beam and Doppler flow signals of LAD was 42 +/- 8 degrees. The ratio of AT to total diastolic spectral duration was 0.19 +/- 0.088 and constant with age. LAD peak flow velocity correlated significantly with age (r = -0.57, p < 0.0001) and heart rate (r = 0.63, p < 0.0001). Multiple linear regression analysis showed that LAD peak flow velocity was associated with age and heart rate (LAD peak flow velocity = 20-0.34 (age) + 0.16 (heart rate), r2 = 0.41, p < 0 .0001). Normal data obtained in the present study provide a basis of the understanding and investigation in children with congenital heart disease or acquired heart disease such as atherosclerosis, left ventricular hypertrophy, or Kawasaki's disease.     

Flow measurement by cardiovascular magnetic resonance: a multi-centre multi-vendor study of background phase offset errors that can compromise the accuracy of derived regurgitant or shunt flow measurements

Aims

Cardiovascular magnetic resonance (CMR) allows non-invasive phase contrast measurements of flow through planes transecting large vessels. However, some clinically valuable applications are highly sensitive to errors caused by small offsets of measured velocities if these are not adequately corrected, for example by the use of static tissue or static phantom correction of the offset error. We studied the severity of uncorrected velocity offset errors across sites and CMR systems.

Methods and Results

In a multi-centre, multi-vendor study, breath-hold through-plane retrospectively ECG-gated phase contrast acquisitions, as are used clinically for aortic and pulmonary flow measurement, were applied to static gelatin phantoms in twelve 1.5 T CMR systems, using a velocity encoding range of 150 cm/s. No post-processing corrections of offsets were implemented. The greatest uncorrected velocity offset, taken as an average over a ''great vessel'' region (30 mm diameter) located up to 70 mm in-plane distance from the magnet isocenter, ranged from 0.4 cm/s to 4.9 cm/s. It averaged 2.7 cm/s over all the planes and systems. By theoretical calculation, a velocity offset error of 0.6 cm/s (representing just 0.4% of a 150 cm/s velocity encoding range) is barely acceptable, potentially causing about 5% miscalculation of cardiac output and up to 10% error in shunt measurement.

Conclusion

In the absence of hardware or software upgrades able to reduce phase offset errors, all the systems tested appeared to require post-acquisition correction to achieve consistently reliable breath-hold measurements of flow. The effectiveness of offset correction software will still need testing with respect to clinical flow acquisitions.