Assessment of Ultrasound Elastography for Orthopedic Applications

Ultrasound imaging is emerging as an attractive alternative modality to standard x-ray and CT methods for bone assessment applications. The high reflectivity at the bone/soft tissue interface that occurs due to high acoustic impedance mismatch presents an important diagnostic opportunity affording the detection of abnormalities at bone surfaces with high accuracy and contrast-to-noise ratios. Furthermore, the mechanical properties of the soft tissue surrounding the bones undergo changes depending on the integrity of the underlying bone, viz. intact, fractured or healing. Unlike other imaging modalities, ultrasound elastography techniques, with their sensitivity to variations in soft tissue stiffness, are able to assist with monitoring bone regrowth. However, there is presently a lack of systematic studies that investigate the performance of diagnostic ultrasound techniques in bone imaging applications. This dissertation aims at understanding the performance limitations of new ultrasound techniques for assessing intact and fractured bones in vitro as well as in vivo. Ultrasound based 2D, 3D and elastography imaging experiments were performed on in vitro and in vivo samples of mammalian as well as non-mammalian bones. Ultrasound measurements of controlled defects were statistically compared with those obtained from the same samples using alternate imaging modalities. The performance of axial strain elastograms and axial shear strain elastograms at the soft tissue/bone interface was also studied in intact and fractured bones, and statistical analysis was carried out using elastographic image quality tools. The results of this study demonstrate that it is feasible to use diagnostic ultrasound imaging techniques to assess bone defects in real time and with high accuracy and precision. The relative strength of the axial strains and the axial shear strains at the bone/soft tissue interface with respect to the background soft tissue reduce in the presence of a fracture. Consequently, the study concluded that a combination of these imaging modalities might provide information regarding the integrity of the underlying bone and also an insight into the severity of the fractures, alignment of bone fragments and the progress of bone healing. In the future, ultrasound imaging techniques might provide a cost-effective, real-time, safe and portable diagnostic tool for bone imaging applications