Local compression in automated breast ultrasound in the mammographic geometry

Background, Motivation and Objective: Automated ultrasound scanning (AUS) of the breast has developed more slowly than anticipated. The main limitation, beyond achieving adequate acoustic coupling to the breast, has been excessive shadow artifacts, as reflecting structures at acute angles to the ultrasound beam are not flattened by the transducer as well as in manual scanning. We believe that imaging of the breast in near mammographic compression provides much of the needed flattening. The question under initial study in this effort is, whether in breast AUS under very light mammographic compression, local compression by the transducer might flatten the acutely oriented structures further and reduce the acoustic path length to key structures in the breast. We suspect these improvements will be possible without distorting the breast so dramatically that the lesion registration advantages of scanning the breast in the same system as mammography or digital breast tomosynthesis (DBT) are not realized. Preliminary tests are reported here, as well as design of a system for a more refined human study. Statement of Contribution/Methods: Initial imaging tests were performed in our combined AUS/DBT system. A fiber mesh, loosened slightly in its frame, replaced the standard plastic mammography compression paddle. The transducer, in contact with the mesh and the breast, was translated by motors. The compression force of the linear array transducer on its vertical was manually controlled. Breast phantoms and the breasts of three women were scanned with usual compression by the mesh paddle and then with less global, but added local, compression. Results: Examples of flattened structures were observed more brightly in the locally compressed breasts, and acoustic paths longer than 35 mm were reduced, by ~10 mm. In many areas image penetration was 3 cm greater. In one case, image volumes w/wo local compression were spatially aligned by nonlinear image registration software. Discussion and Conclusions: Visual indicators of image features expected to provide improved ultrasonic imaging were observed with local compression and lateral movement of tissues appeared acceptable. These results motivated design and construction of an apparatus to make local compression practical and safe. It utilizes joystick control of the vertical compression force during scanning, realized by pneumatic actuators attached to the transducer. The air pressure applied to these actuators is also applied to actuators in the joystick for force feedback to the operator. Two miniature vibrators attached to the joystick provide vibrotactile feedback of the reaction torques computed from the measurements of 6 force sensors on the transducer holder. The fail-safe system design insures no pneumatic compression force application to the breast in case of power loss or emergency shutdown.