423 research outputs found

    Breast Ultrasound Past, Present, and Future

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    This chapter will review the utilization of breast ultrasound for screening and diagnostic purposes. Currently, ultrasound is primarily used to investigate palpable lesions in women less than 30 years old, to provide further characterization of abnormal mammographic findings, and to guide invasive breast interventions. Innovations in ultrasound technology have improved the detection and diagnosis of breast cancer. Computer-aided detection (CAD), elastography, quantitative breast ultrasound technology, and ultrasound contrast agents (microbubbles) were developed to improve diagnostic accuracy. These advancements have the potential to impact overall survival by detecting cancers that are smaller and less aggressive

    Visual Feedback System for Ultrasound Training

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    Goggle Augmented Imaging and Navigation System for Fluorescence-Guided Surgery

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    Surgery remains the only curative option for most solid tumors. The standard-of-care usually involves tumor resection and sentinel lymph node biopsy for cancer staging. Surgeons rely on their vision and touch to distinguish healthy from cancer tissue during surgery, often leading to incomplete tumor resection that necessitates repeat surgery. Sentinel lymph node biopsy by conventional radioactive tracking exposes patients and caregivers to ionizing radiation, while blue dye tracking stains the tissue highlighting only superficial lymph nodes. Improper identification of sentinel lymph nodes may misdiagnose the stage of the cancer. Therefore there is a clinical need for accurate intraoperative tumor and sentinel lymph node visualization. Conventional imaging modalities such as x-ray computed tomography, positron emission tomography, magnetic resonance imaging, and ultrasound are excellent for preoperative cancer diagnosis and surgical planning. However, they are not suitable for intraoperative use, due to bulky complicated hardware, high cost, non-real-time imaging, severe restrictions to the surgical workflow and lack of sufficient resolution for tumor boundary assessment. This has propelled interest in fluorescence-guided surgery, due to availability of simple hardware that can achieve real-time, high resolution and sensitive imaging. Near-infrared fluorescence imaging is of particular interest due to low background absorbance by photoactive biomolecules, enabling thick tissue assessment. As a result several near-infrared fluorescence-guided surgery systems have been developed. However, they are limited by bulky hardware, disruptive information display and non-matched field of view to the user. To address these limitations we have developed a compact, light-weight and wearable goggle augmented imaging and navigation system (GAINS). It detects the near-infrared fluorescence from a tumor accumulated contrast agent, along with the normal color view and displays accurately aligned, color-fluorescence images via a head-mounted display worn by the surgeon, in real-time. GAINS is a platform technology and capable of very sensitive fluorescence detection. Image display options include both video see-through and optical see-through head-mounted displays for high-contrast image guidance as well as direct visual access to the surgical bed. Image capture options from large field of view camera as well high magnification handheld microscope, ensures macroscopic as well as microscopic assessment of the tumor bed. Aided by tumor targeted near-infrared contrast agents, GAINS guided complete tumor resection in subcutaneous, metastatic and spontaneous mouse models of cancer with high sensitivity and specificity, in real-time. Using a clinically-approved near-infrared contrast agent, GAINS provided real-time image guidance for accurate visualization of lymph nodes in a porcine model and sentinel lymph nodes in human breast cancer and melanoma patients with high sensitivity. This work has addressed issues that have limited clinical adoption of fluorescence-guided surgery and paved the way for research into developing this approach towards standard-of-care practice that can potentially improve surgical outcomes in cancer

    In Vivo Vascular Imaging with Photoacoustic Microscopy

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    Photoacoustic (PA) tomography (PAT) has received extensive attention in the last decade for its capability to provide label-free structural and functional imaging in biological tissue with highly scalable spatial resolution and penetration depth. Compared to modern optical modalities, PAT offers speckle-free images and is more sensitive to optical absorption contrast (with 100% relative sensitivity). By implementing different regimes of optical wavelength, PAT can be used to image diverse light-absorbing biomolecules. For example, hemoglobin is of particular interest in the visible wavelength regime owing to its dominant absorption, and lipids and water are more commonly studied in the near-infrared regime. In this dissertation, one challenge was to quantitatively investigate red-blood-cell dynamics in nailfold capillaries with single-cell resolution PA microscopy (PAM). We recruited healthy volunteers and measured multiple hemodynamic parameters based on individual red blood cells (RBCs). Statistical analysis revealed the process of oxygen release and changes in flow speed for RBCs in a capillary. For the first time on record, oxygen release from individual RBCs in human capillaries was imaged with nearly real-time speed, and the work paved the way for our following study of a specific blood disorder. We next conducted a pilot study on sickle cell disease (SCD), measuring and comparing the parameters related to RBC dynamics between healthy subjects and patients with SCD. In the patient group, we found that capillaries tended to be more tortuous, dilated, and had higher number density. In addition, abnormal RBCs tended to have lower oxygenation in the inlet of a capillary, from where they flowed slower and released a larger fraction of oxygen than normal RBCs. As the only imaging modality able to observe the real-time dynamics of the oxygen release of individual RBCs, PAM provides medically valuable information for diagnostic purposes. As the last focus of this dissertation, we tackled the limited view problem in PAM by introducing an off-axis illumination technique for complementing the original detection view. We demonstrated this technique numerically and then experimentally on phantoms and animals. This simple but very effective method revealed abundant vertical vasculature in a mouse brain that had long been missed by conventional top-illumination PAM. This technique greatly advances future studies on neurovascular responses in mouse brains

    Breast Imaging and Translation into Targeted Oncoplastic Breast Surgery

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    Preoperative staging of breast cancer based on breast imaging is mandatory. Breast imaging encompasses mammography, breast sonography and MR-mammography. Earlier diagnosis of breast cancer results in a favourable oncological outcome. Limitations and influences on operative procedures of MR-mammography in diagnosis and staging of breast cancer have to be discussed. Different interventional procedures have been developed. The histological results of interventional procedures guided by ultrasound, stereotactic mammography or magnetic resonance have to be integrated in planning surgical resection margins in oncoplastic breast-conserving surgery. Image-guided wire markings are an important tool for planning these surgical resection margins. This chapter summarises the results of breast imaging, interventional procedures and wire markings for the breast-conserving therapy of breast cancer. Breast imaging and interventional procedures are the basis for a concept of targeted oncoplastic breast surgery

    Ultrasound Guidance in Perioperative Care

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    Ultrasound Guidance in Perioperative Care

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    Development and Validation of Mechatronic Systems for Image-Guided Needle Interventions and Point-of-Care Breast Cancer Screening with Ultrasound (2D and 3D) and Positron Emission Mammography

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    The successful intervention of breast cancer relies on effective early detection and definitive diagnosis. While conventional screening mammography has substantially reduced breast cancer-related mortalities, substantial challenges persist in women with dense breasts. Additionally, complex interrelated risk factors and healthcare disparities contribute to breast cancer-related inequities, which restrict accessibility, impose cost constraints, and reduce inclusivity to high-quality healthcare. These limitations predominantly stem from the inadequate sensitivity and clinical utility of currently available approaches in increased-risk populations, including those with dense breasts, underserved and vulnerable populations. This PhD dissertation aims to describe the development and validation of alternative, cost-effective, robust, and high-resolution systems for point-of-care (POC) breast cancer screening and image-guided needle interventions. Specifically, 2D and 3D ultrasound (US) and positron emission mammography (PEM) were employed to improve detection, independent of breast density, in conjunction with mechatronic and automated approaches for accurate image acquisition and precise interventional workflow. First, a mechatronic guidance system for US-guided biopsy under high-resolution PEM localization was developed to improve spatial sampling of early-stage breast cancers. Validation and phantom studies showed accurate needle positioning and 3D spatial sampling under simulated PEM localization. Subsequently, a whole-breast spatially-tracked 3DUS system for point-of-care screening was developed, optimized, and validated within a clinically-relevant workspace and healthy volunteer studies. To improve robust image acquisition and adaptability to diverse patient populations, an alternative, cost-effective, portable, and patient-dedicated 3D automated breast (AB) US system for point-of-care screening was developed. Validation showed accurate geometric reconstruction, feasible clinical workflow, and proof-of-concept utility across healthy volunteers and acquisition conditions. Lastly, an orthogonal acquisition and 3D complementary breast (CB) US generation approach were described and experimentally validated to improve spatial resolution uniformity by recovering poor out-of-plane resolution. These systems developed and described throughout this dissertation show promise as alternative, cost-effective, robust, and high-resolution approaches for improving early detection and definitive diagnosis. Consequently, these contributions may advance breast cancer-related equities and improve outcomes in increased-risk populations and limited-resource settings

    Focal Spot, Fall/Winter 1996

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    https://digitalcommons.wustl.edu/focal_spot_archives/1071/thumbnail.jp
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