Search Results (48)

This paper presents the PRONOBIS project, an ultrasound-only, robotically assisted, deep learning-based system for prostate scanning and biopsy treatment planning. The proposed system addresses the challenges of precise prostate segmentation, reconstruction and inter-operator variability by performing fully automated prostate scanning, real-time CNN-transformer-based image processing, 3D prostate reconstruction, and biopsy needle position planning. Fully automated prostate scanning is achieved by using a robotic arm equipped with an ultrasound system. Real-time ultrasound image processing utilizes state-of-the-art deep learning algorithms with intelligent post-processing techniques for precise prostate segmentation. To create a high-quality prostate segmentation dataset, this paper proposes a deep learning-based medical annotation platform, MedAP. For precise segmentation of the entire prostate sweep, DAF3D and MicroSegNet models are evaluated, and additional image post-processing methods are proposed. Three-dimensional visualization and prostate reconstruction are performed by utilizing the segmentation results and robotic positional data, enabling robust, user-friendly biopsy treatment planning. The real-time sweep scanning and segmentation operate at 30 Hz, which enable complete scan in 15 to 20 s, depending on the size of the prostate. The system is evaluated on prostate phantoms by reconstructing the sweep and by performing dimensional analysis, which indicates 92% and 98% volumetric accuracy on the tested phantoms. Three-dimansional prostate reconstruction takes approximately 3 s and enables fast and detailed insight for precise biopsy needle position planning. Full article

Background: Intraoperative ultrasound (IOUS) provides real-time imaging during brain tumor surgery but remains underused in brain metastasis resection. This study evaluates the effectiveness of 2D IOUS in improving the extent of resection compared to standard neuronavigation. Methods: We retrospectively analyzed 55 adult patients with brain metastases treated surgically at a single center. Patients were divided into two groups: IOUS-guided surgery (n = 20) and standard neuronavigation (n = 35). Gross total resection (GTR) was defined as the extent of resection > 96%, assessed volumetrically. Statistical analyses included chi-square tests, logistic regression, and ROC curve analysis. Results: GTR > 96% was achieved in 80% of IOUS-guided cases compared to 42.86% in the control group (p = 0.008). IOUS significantly increased the odds of achieving GTR (OR = 5.33, p = 0.011). Larger tumor volume reduced the likelihood of GTR (OR = 0.469, p = 0.025), but this effect was mitigated by IOUS use (interaction OR = 1.986, p = 0.044). The regression model showed excellent discrimination (AUC = 0.930, p < 0.001). Functional outcomes improved postoperatively in both groups. Conclusions: 2D IOUS significantly enhances the extent of resection in brain metastasis surgery, including that for larger tumors. Its accessibility, real-time feedback, and low cost support its wider adoption in neurosurgical practice, especially in settings with limited resources. Full article

Background: Gallbladder hypomotility is a key pathogenic factor in cholelithiasis. Non-invasive interventions to enhance gallbladder contractility remain limited. Ultrasound therapy has shown promise in various muscular disorders, but its effects on gallbladder function are unexplored. Methods: This study employed low-intensity pulsed ultrasound (LIPUS) at a 3 MHz frequency and 0.8 W/cm² intensity with a 20% duty cycle to irradiate the gallbladder region of fasting guinea pigs. Gallbladder contractile function was evaluated through multiple complementary approaches: in vivo assessment via two-dimensional/three-dimensional ultrasound imaging to monitor volumetric changes; quantitative functional evaluation using nuclear medicine scintigraphy (^99mTc-HIDA); and ex vivo experiments including isolated gallbladder muscle strip tension measurements, histopathological analysis, α-smooth muscle actin (α-SMA) immunohistochemistry, and intracellular calcium fluorescence imaging. Results: Ultrasound significantly enhanced gallbladder emptying, evidenced by the volume reduction and increased ejection fraction. Scintigraphy confirmed accelerated bile transport in treated animals. Ex vivo analyses demonstrated augmented contractile force, amplitude, and frequency in ultrasound-treated smooth muscle. Histological examination revealed smooth muscle hypertrophy, α-SMA upregulation, and elevated intracellular calcium levels. Extended ultrasound exposure produced sustained functional improvements without tissue damage. Conclusions: Ultrasound effectively enhances gallbladder contractile function through mechanisms involving smooth muscle structural modification and calcium signaling modulation. These findings establish the experimental foundation for ultrasound as a promising non-invasive therapeutic approach to improve gallbladder motility and potentially prevent gallstone formation. Full article

Background: Hyaluronic acid (HA) has emerged as a favored adjunct to restore volume after blepharoplasty and is very effective in the treatment of postoperative hollowness, sagging, and asymmetry. Its efficacy, rate of complications, and optimal injection technique are different in different clinical studies. Hyaluronidase has been studied by diverse methods in the treatment of HA complications, including chronic edema and surgical distortion. This study critically evaluated the efficacy, safety, and technical aspects of HA in the context of blepharoplasty outcomes. Methods: A systematic review was performed to evaluate the use of HA and hyaluronidase for post-blepharoplasty volume rejuvenation and the treatment of complications. Studies describing HA injection technique, time interval between blepharoplasty and injection, volumetric maintenance, complication rates, esthetic and functional results, and patient satisfaction scores were considered. Risk of bias was estimated with the ROBINS-I tool. Results: Sample sizes across the five included studies ranged from 5 to 109 patients, and follow-up intervals ranged from 1 month to 7 years. The age of patients ranged from 31 to 76 years, and females accounted for 86% of the participants in some studies. Injection of HA successfully restored meaningful volume, with retention persisting for over 12 months in the majority of cases. HA preoperative injection caused significant patient satisfaction in a short duration and was not associated with severe complications; delayed injection caused slight distortions in some revision operations. Lipofilling showed a reduced rate of complications (12%) compared with isolated blepharoplasty (20%), suggesting its utility as an adjuvant procedure of volume restoration. Hyaluronidase successfully treated recalcitrant edema, with improvements ranging from 50% to 100%, while the application of adjuvant RF microneedling caused complete remission (100%) in subjects with multiple treatments. The application of ultrasound imaging made measurements more precise, although methods of clinical assessment were significantly heterogeneous among the studies. Conclusions: HA displayed efficacy in terms of efficient volume restoration after blepharoplasty, especially when technique, time, and filler selection are meticulously optimized. In comparison to lipofilling, HA is seen as somewhat safer because of its reversibility and lower likelihood of adverse vascular events. Nonetheless, considerable variability in filler type, amount, timing of administration, and result evaluation constrains conclusive clinical recommendations. The use of hyaluronidase is an effective remedial approach for overcorrection or ongoing edema. Full article

The accurate assessment of muscle morphology and function is crucial for medical diagnostics, rehabilitation, and biomechanical research. This study presents a novel methodology for constructing volumetric models of forearm muscles based on three-dimensional ultrasound imaging integrated with a robotic system to ensure precise probe positioning and controlled pressure application. The proposed ultrasound scanning approach combined with a collaborative six-degrees-of-freedom robotic manipulator enabled reproducible and high-resolution imaging of muscle structures in both relaxed and contracted states. A custom-built phantom, acoustically similar to biological tissues, was developed to validate the method. The cross-sectional area of the muscles and the coordinates of the center of mass of the sections, as well as the volume and center of gravity of each muscle, were calculated for each cross-section of the reconstructed forearm muscle models at contraction. The method’s feasibility was confirmed by comparing the reconstructed volumes with anatomical data and phantom measurements. This study highlights the advantages of robotic-assisted ultrasound imaging for non-invasive muscle assessment and suggests its potential applications in neuromuscular diagnostics, prosthetics design, and rehabilitation monitoring. Full article

This study investigates the impact of low-intensity continuous ultrasound (LICU) on pancreatic adenocarcinoma (PANC-1) spheroids, emphasizing morphological and volumetric transformations. PANC-1 spheroids were cultured and treated with LICU across frequencies from 1 to 5 MHz. Cell viability and mortality were analyzed through Calcein AM/PI staining, while volumetric and morphological changes were quantified across frequencies from 2 to 4 MHz using advanced imaging techniques and computational tools, including a custom Python OpenCv Library, AnaSP 3.0, a MATLAB based open source tool. Notably, a frequency of 3.5 MHz yielded optimal outcomes, also achieving a reduction in spheroid volume and mortality while minimizing disgregation, a factor linked to metastasis risk. These findings underscore LICU’s potential as an effective therapeutic strategy, balancing tumor reduction with the preservation of structural cohesion. The study establishes a methodological framework for optimizing LICU parameters, presenting a less invasive avenue for improving therapeutic outcomes in pancreatic cancer treatment. Full article

Background/Objectives: Alzheimer’s disease (AD) is characterized by progressive brain atrophy marked by cognitive decline and memory loss, which significantly affect patients’ quality of life. Transcranial ultrasound stimulation (TUS) is a potential physical treatment for AD patients. However, the specific brain regions stimulated by TUS and its therapeutic effects remain unclear. Methods: In this study, magnetic resonance imaging (MRI) and FreeSurfer segmentation were employed to assess alterations in the brain volume of AD patients after TUS. Results: Our findings revealed significant volume increases in the corpus callosum (CC) and lateral orbitofrontal cortex (lOFC) in the TUS group. Moreover, the volumetric changes in the CC were strongly correlated with improvements in the Mini-Mental State Examination score, which is a widely used measure of cognitive function of AD patients. Conclusions: TUS has the potential to alleviate disease progression and offers a non-invasive therapeutic approach to the improvement of cognitive function in AD patients. Full article

Genetically determined left ventricular excessive trabeculation (LVET) has a wide clinical spectrum ranging from asymptomatic subjects to severe heart failure with arrhythmias and thromboembolic events. Unlike other cardiomyopathies, the relatives of LVET patients never reach the spotlight of guidelines and clinical practice, although these family members can be often affected by these conditions. Thus, we aimed to investigate the relatives of LVET by multidimensional analysis, such as genetic testing, ECG and cardiac ultrasound (ECHO). We included 55 blood relatives from the family of 18 LVET patients (male = 27, age = 44 ± 20.8y), who underwent anamnesis registration. With Sanger sequencing, the relatives were classified into genetically positive (GEN-pos) and unaffected (GEN-neg) subgroups. In addition to regular ECG parameters, Sokolow-Lyon Index (SLI) values were calculated. 2D ECHO images were analysed with TomTec Arena, evaluating LV volumetric, functional (EF) and strain parameters. Individuals were categorized into JENNI-pos and JENNI-neg morphological subgroups according to the Jenni LVET ECHO criteria. Family history showed frequent involvement (arrhythmia 61%, stroke 56%, syncope 39%, sudden cardiac death 28%, implanted device 28%), as well as personal anamnesis (subjective symptoms 75%, arrhythmias 44%). ECG and ECHO parameters were within the normal range. In terms of genetics, 78% of families and 38% of relatives carried the index mutation. LV_SLI and QT duration were lower in the GEN-pos group; ECHO parameters were comparable in the subgroups. Morphologically, 33% of the relatives met Jenni-LVET criteria were genetically affected and showed lower LV_EF values. The frequently found genetic, morphological and clinical involvement may indicate the importance of screening and, if necessary, regular follow-up of relatives in the genetically affected LVET population. Full article

Background: Acne scarring presents a significant esthetic and psychological concern, commonly classified into atrophic and hypertrophic types. Effectively managing these lesions often involves the use of therapeutic strategies such as laser treatments, dermabrasion, and fillers. This study investigates the efficacy of 1550 nm erbium glass laser therapy in the treatment of atrophic acne scars through a quantitative assessment. Material and Methods: Participants with mild to moderate atrophic acne scars received two sessions of fractional erbium glass laser therapy at one-month intervals. Skin density and epidermal thickness were measured using a high-frequency ultrasound device (DUB SkinScanner), while the Antera 3D imaging system facilitated a comprehensive analysis of skin parameters, including texture, volumetric depressions, and pigmentation. Results: The use of this therapy led to significant improvements across multiple parameters. Skin density and epidermal thickness increased. Significant reductions were observed in fold depth, pore volume, and depression volume, indicating enhanced smoothness and minimized scar appearance. Improvements in texture roughness and pigmentation contributed to a visually coherent skin surface. Conclusions: Fractional erbium glass laser therapy effectively ameliorates the appearance of atrophic acne scars by increasing skin density, reducing dermal depressions, and improving texture and pigmentation uniformity. The Antera 3D system and high-frequency ultrasound device demonstrated high efficacy in capturing subtle changes, supporting its value in clinical applications for optimizing treatment parameters. Full article

Objectives: The aim of the present study was to examine the growth dynamics of the first sacral vertebra and its ossification center in the human fetus, based on their linear, planar, and volumetric parameters. Methods: The examinations were carried out on 54 human fetuses of both sexes (26 males and 28 females) aged 18–30 weeks of gestation, which had been preserved in 10% neutral formalin solution. Using CT, digital image analysis software, 3D reconstruction, and statistical methods, the size of the first sacral vertebra and its ossification center was evaluated. Results: The first sacral vertebra and its ossification center grew proportionately according to fetal weeks. Conclusions: The numerical data obtained from computed tomography and the growth patterns of the body of the first sacral vertebra and its ossification center may serve as age-specific normative intervals relevant for gynecologists, obstetricians, pediatricians, and radiologists during fetal ultrasound screening. Our findings on the growth of the body of the first sacral vertebra and its ossification center may be useful in daily clinical practice, particularly in ultrasonic monitoring of normal fetal growth and in screening for congenital defects and skeletal dysplasias. Full article

In orthopedics, X-rays and computed tomography (CT) scans play pivotal roles in diagnosing and treating bone pathologies. Machine bulkiness and the emission of ionizing radiation remain the main problems associated with these techniques. The accessibility and low risks related to ultrasound handling make it a popular 2D imaging method. Indeed, 3D ultrasound assembles 2D slices into a 3D volume. This study aimed to implement a probe-tracking method for 6 DoF 3D ultrasound. The proposed method involves a dodecahedron with ArUco markers attached, enabling computer vision tracking of the ultrasound probe’s position and orientation. The algorithm focuses on the data acquisition phase but covers the basic reconstruction required for data generation and analysis. In the best case, the analysis revealed an average error norm of 2.858 mm with a standard deviation norm of 5.534 mm compared to an infrared optical tracking system used as a reference. This study demonstrates the feasibility of performing volumetric imaging without ionizing radiation or bulky systems. This marker-based approach shows promise for enhancing orthopedic imaging, providing a more accessible imaging modality for helping clinicians to diagnose pathologies regarding complex joints, such as the shoulder, replacing standard infrared tracking systems known to suffer from marker occlusion problems. Full article

A 43-year-old patient with a history of uterine fibromatosis was referred to our hospital for menometrorrhagia and pelvic pain. At the pelvic ultrasound, a highly-vascularized myometrial lesion in volumetric increase was described. An elongated, solid, hypoechoic, painless, and highly vascularized left parauterine mass was identified. On histological examination, a uterine smooth muscle tumor of uncertain malignant potential (STUMP) with intravascular invasion of the left uterine vein was diagnosed. The adnexa and peritoneum were free of disease. On a retrospective evaluation of the ultrasound images, we noticed that the intravascular lesion showed sonographic features comparable to the original mass. Moreover, the Color Doppler (CD) analysis revealed an interrupted blood flow within the left uterine vein. In this case, the ultrasound proved to be an accurate diagnostic tool. When inhomogeneous uterine masses are suspected, and a parauterine/paraadnexal mass surrounded by irregular vessels are identified, the sonographer should take into account a risk of intravascular invasion. The patency of uterine and ovarian vessels should be accurately evaluated, to guide a tailored patient surgical approach. Full article

A protocol is proposed to acquire a tomographic ultrasound (US) scan of the musculoskeletal (MSK) anatomy in the rotator cuff region. Current clinical US imaging techniques are hindered by occlusions and a narrow field of view and require expert acquisition and interpretation. There is limited literature on 3D US image registration of the shoulder or volumetric reconstruction of the full shoulder complex. We believe that a clinically accurate US volume reconstruction of the entire shoulder can aid in pre-operative surgical planning and reduce the complexity of US interpretation. The protocol was used in generating data for deep learning model training to automatically register US mosaics in real-time. An in vivo 3D US tomographic reconstruction of the entire rotator cuff region was produced by registering 53 sequential 3D US volumes acquired by an MSK sonographer. Anatomical surface thicknesses and distances in the US mosaic were compared to their corresponding MRI measurements as the ground truth. The humeral head surface was marginally thicker in the reconstructed US mosaic than its original thickness observed in a single US volume by 0.65 mm. The humeral head diameter and acromiohumeral distance (ACHD) matched with their measured MRI distances with a reconstruction error of 0 mm and 1.2 mm, respectively. Furthermore, the demonstration of 20 relevant MSK structures was independently graded between 1 and 5 by two sonographers, with higher grades indicating poorer demonstration. The average demonstration grade for each anatomy was as follows: bones = 2, muscles = 3, tendons = 3, ligaments = 4–5 and labrum = 4–5. There was a substantial agreement between sonographers (Cohen’s Weighted kappa of 0.71) on the demonstration of the structures, and they both independently deemed the mosaic clinically acceptable for the visualisation of the bony anatomy. Ligaments and the labrum were poorly observed due to anatomy size, location and inaccessibility in a static scan, and artefact build-up from the registration and compounding approaches. Full article

Convolutional neural networks (CNNs), initially developed for image processing applications, have recently received significant attention within the field of medical ultrasound imaging. In this study, passive cavitation imaging/mapping (PCI/PAM), which is used to map cavitation sources based on the correlation of signals across an array of receivers, is evaluated. Traditional reconstruction techniques in PCI, such as delay-and-sum, yield high spatial resolution at the cost of a substantial computational time. This results from the resource-intensive process of determining sensor weights for individual pixels in these methodologies. Consequently, the use of conventional algorithms for image reconstruction does not meet the speed requirements that are essential for real-time monitoring. Here, we show that a three-dimensional (3D) convolutional network can learn the image reconstruction algorithm for a $16\times 16$ element matrix probe with a receive frequency ranging from 256 kHz up to $1.0$ MHz. The network was trained and evaluated using simulated data representing point sources, resulting in the successful reconstruction of volumetric images with high sensitivity, especially for single isolated sources (100% in the test set). As the number of simultaneous sources increased, the network’s ability to detect weaker intensity sources diminished, although it always correctly identified the main lobe. Notably, however, network inference was remarkably fast, completing the task in approximately 178 s for a dataset comprising 650 frames of ${41}^3$ volume images with signal duration of $20\mathsf{\mu }\mathrm{s}$. This processing speed is roughly thirty times faster than a parallelized implementation of the traditional time exposure acoustics algorithm on the same GPU device. This would open a new door for PCI application in the real-time monitoring of ultrasound ablation. Full article

Background: The aim of this study was to validate externally a nomogram that relies on MRI volumetric parameters and clinical data to determine the need for a standard biopsy in addition to a target biopsy for men with suspicious prostate MRI findings. Methods: We conducted a retrospective analysis of a prospectively maintained database of 469 biopsy-naïve men who underwent prostate biopsies. These biopsies were guided by pre-biopsy multiparametric Magnetic Resonance Imaging (mpMRI) and were performed at two different institutions. We included men with a PIRADSsv 2.1 score from 3 to 5. Each patient underwent both an MRI–ultrasound fusion biopsy of identified MRI-suspicious lesions and a systematic biopsy according to our protocol. The lesion volume percentage was determined as the proportion of cancer volume on MRI relative to the entire prostate volume. The study’s outcomes were iPCa (Gleason Grade Group 1) and csPCa (Gleason Grade Group > 1). We evaluated the model’s performance using AUC decision curve analyses and a systematic analysis of model-derived probability cut-offs in terms of the potential to avoid diagnosing iPCa and to accurately diagnose csPCa. Results: The nomogram includes age, PSA value, prostate volume, PIRADSsv 2.1 score, percentage of MRI-suspicious lesion volume, and lesion location. AUC was determined to be 0.73. By using various nomogram cut-off thresholds (ranging from 5% to 30%), it was observed that 19% to 58% of men could potentially avoid undergoing standard biopsies. In this scenario, the model might miss 0% to 10% of diagnosis of csPCa and could prevent identifying 6% to 31% of iPCa cases. These results are in line with findings from the multi-institutional external validation study based on the IMPROD trial (n = 122) and the MULTI-IMPROD trial (n = 262). According to DCA, the use of this nomogram led to an increased overall net clinical benefit when the threshold probability exceeded 10%. Conclusions: This study supports the potential value of a model relying on MRI volumetric measurements for selecting individuals with clinical suspicion of prostate cancer who would benefit from undergoing a standard biopsy in addition to a targeted biopsy. Full article