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Imaging Artifacts of Medical Instruments in Ultrasound-Guided Interventions

Department of Cardiology, Division of Basic Cardiovascular Research, Children’s Hospital Boston, Boston, Massachusetts USA (J.H., J.K.T., N.V.V.); Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan (Y.S.); and Department of Aerospace and Mechanical Engineering, Boston University, Boston, Massachusetts USA (R.O.C., P.E.D.).

Address correspondence to Pierre E. Dupont, PhD, Department of Aerospace and Mechanical Engineering, Boston University, 110 Cummington St, Boston, MA 02215 USA..,E-mail: pierre{at}bu.edu

Objective. Real-time 3-dimensional (3D) ultrasound imaging has the potential to become a dominant imaging technique for minimally invasive surgery. One barrier to its widespread use is that surgical instruments generate imaging artifacts, which can obfuscate their location, orientation, and geometry and obscure nearby tissue. The purpose of this study was to identify and describe the types of artifacts which could be produced by metallic instruments during interventions guided by 3D ultrasound imaging. Methods. Three imaging studies were performed. First, imaging artifacts from stainless steel rods were identified in vitro and acoustically characterized. Second, 3 typical minimally invasive instruments were imaged (in vitro and in vivo), and their artifacts were analyzed. The third study compared the intensity of imaging artifacts (in vitro and in vivo) from stainless steel rods with rods composed of 3 different materials and stainless steel rods with roughened and coated surfaces. Results. For the stainless steel rods, all observed artifacts are described and illustrated, and their physical origins are explained. Artifacts from the 3 minimally invasive instruments are characterized with the use of the artifacts observed with the rods. Finally, it is shown that artifacts can be greatly reduced through the use of alternate materials or by surface modification. Conclusions. Instrument artifacts in 3D ultrasound images can be more confusing than those from the same instruments imaged in 2 dimensions. Real-time 3D ultrasound imaging can, however, be used effectively for in vivo imaging of minimally invasive instruments by using artifact mitigation techniques, including careful selection of probe and incision locations, as well as by instrument modification.

Key Words: imaging artifacts • medical instruments • ultrasound-guided interventions

Abbreviations: 3D, 3-dimensional • 2D, 2-dimensional

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