# Patent

## Title
Process and system for simulation or digital synthesis of sonographic images

## Abstract

The invention relates to a method for the simulation or digital synthesis of echographic images, characterised by the direct transformation in real time, or quasi real time, of the information contained in a 3D scanographic (or tomodensitometric) medical or veterinary image, without delimitation or segmentation of the bodies or structures contained in the volume of scanographic data, according to at least one two-dimensional observation window which can be modified in real time, or quasi real time, in terms of the dimension, position, directions and orientation thereof, the characteristics thereof depending on the type of virtual echographic probe determined, and reproducing all of the attenuation, reflection, refraction and dispersion effects, and the regulation effects of a real echographic image, each echographic image supplied cumulating the results of the simulations of the pre-cited effects.

## Background
BACKGROUND OF THE INVENTION
This invention relates to the field of imaging and exploration techniques, in particular in the medical field and more particularly within the context of the simulation or the synthesis of virtual images, and it has as its object a process and a system for simulation or digital synthesis of flat and even three-dimensional sonographic images.
So as to train its students, modern medicine is beginning to acquire increasingly improved medical simulators.
DESCRIPTION OF THE RELATED ART
The simulators have proven their value in the military and aeronautical fields and offer a rather significant number of advantages:

    
    
        The simulator does not monopolize equipment that is useful to the actual activity,
        The diversity of the simulated cases is very significant, from the common situation up to rare cases,
        Aids that were inconceivable in traditional training can be installed: to watch all or part of its actions from an identical or different viewpoint or to be able to restart the unsatisfactory portion of the simulation as many times as necessary,
        The simulation makes possible a reliable and objective evaluation of the acquired aptitudes,
        The simulation primarily makes it possible to simulate situations in which the risks are very high for novices and/or the patient.
    
    


Thus, within the framework of sonographic apprenticeship and to make it possible in particular during training sessions with surgeons to monitor the positioning and the movement of instruments within the body of a patient, a need exists for a process and a tool that can synthesize sonographic images in real time or quasi-real time.
Sonography, whose technique and characteristics are well known to one skilled in the art, offers many advantages relative to the other imaging techniques: it is not harmful like radiography and scanning; the cost of the equipment and that of the examinations is lower; and the space requirement for the sonographs is small. In addition, in a large majority of cases, before prescribing a more intensive examination such as scanning, a sonography of the zone that is involved in the pathology of the patient is carried out. Finally, the rapid image acquisition imparts thereto a dynamic nature that is very advantageous for observation or guidance.
SUMMARY OF THE INVENTION
The principle of the invention rests on the direct transformation of CT (tomodensitometric) medical images, hereinafter also named scanographic images, into sonographic images. So as to understand the invention, it is therefore necessary to describe succinctly the principles of these different images.
The tomodensitometry is a three-dimensional medical imaging technique that is based on the detection of an x-ray beam rotating around a patient and treated electronically and then digitized. This acquisition thus is carried out by moving—by rotation—an X-ray tube combined with a detection unit, whereby the patient is placed between the tube and the detectors. The CT image is therefore a transmission image. Actually, the x-ray beam, when passing through the body, is attenuated by absorption and by diffusion (photoelectric and Compton effects). This attenuation depends on the density of the medium, its atomic composition and the energy of the x-ray beam. The attenuation of a monochromatic beam by an object of uniform density responds to the following law:
l=lo exp. (-yL) with :lo :x-ray flow at the inlet 1: x-ray flow at the outlet μ; lineic attenuation coefficient of the medium L: thickness of the medium that is passed through
For a more complex object that consists of small elements of identical volumes but different densities, it is possible to calculate the sum of lineic attenuation coefficients along this object by the formula: Σμ;=(1/L).ln(lo/l) with: μi: lineic attenuation coefficient of the element i L: width of each three-dimensional element. The reconstruction process based on sampled measurements will result in a matrix of two-dimensional image, whose content of each pixel represents the attenuation coefficient of an elementary volume whose section is equal to the pixel (generally 0.5 to 2 mm on a side), and the depth is equal to the width of the x-ray beam passing through the patient (section thickness of generally 1 to 10 mm).
Ultimately, the physical parameter at the base of the contrast in a CT image is the lineic attenuation coefficient μ. The value Ns of each pixel of the image is connected to the values of μ by the equation:

Ns=μnSin ̃μea<<×1000

This equation results in a standardized scale (HOUNSFIELD scale) that is currently used in all scanners; it is based on two particular values: −1000 for air and 0 for water. In practice, it extends beyond +1000 for dense bone and radio-opaque structures.
Sonography is a medical imaging technique that uses ultrasound to obtain an image inside the body. The probe of the sonograph sends ultrasound that returns to the probe after being reflected on the organ that it is desired to study, so as to be processed by a computer, The sonographic image is therefore a reflective image. The reflection of the ultrasonic beam is done on interfaces that are constituted by tissues that have different acoustic impedances and also to a lesser extent on the irregularities of these tissues because of the dispersion. The ultrasonic pulses obey the same laws of propagation, reflection and refraction as those of optics. Finally the ultrasonic beam is attenuated based on the nature of the organs through which it passes.
The decisive parameters in the propagation of sounds in the various media are density or mass by volume (d) and the sound propagation speed (v).
The acoustic impedance (Z) is defined by the product of these two characteristics of the medium: Z=d×v. The table below indicates the acoustic impedances for different media that are present in all human or animal bodies.
The four physical phenomena that come into play in the behavior of an ultrasonic wave are: reflection refraction attenuation and dispersion.
a) Reflection and Refraction
An echo is a sound (acoustic wave) that is reflected and that is received after a latent period, corresponding to its period of movement in the medium concerned. When the ultrasonic beam arrives on a reflective surface with an oblique angle, a portion of the beam is reflected with a reflection angle that is equal to the incidence angle. This is a reflection phenomenon. The portion that is transmitted is deflected with an angle that depends on the propagation speed of the two media that are involved. This is a refraction phenomena (see FIG. 1, attached). The proportion of reflected ultrasound, or reflection coefficient, is linked directly to the acoustic impedance difference between the two media. This magnitude is characteristic of the nature of the media. It is located at nominal incidence because as soon as the incidence angle is more than 12°, the reflected energy decreases by a factor of 104: this is equivalent to saying that the reflected beam is no longer picked up. Several reflective coefficients for sonography can be calculated from acoustic impedances. The results of these calculations are indicated in the table below:
These values show that in the body, the great acoustic impedance differences are encountered between the soft tissues and air and between the soft tissues and the hard tissues (bone stones, foreign bodies). Such interfaces are very reflective or very “echogenic” (echo generators). Behind these interfaces a shadow zone appears since much of the acoustic signal has been reflected.
In sonography the interaction of the ultrasonic beam with a smooth oblique surface entrains a disappearance of the signal, because no acoustic signal returns directly to the probe after the oblique reflection and the beam changes direction after the refraction. This phenomenon is responsible for an artifact that is frequently called an “edge shadow.” The influence of the angle of the ultrasound on the sonographic aspect of the organic structures that are observed is more or less marked. The tendons and the ligaments take place fill the so-called anisotropic structures for which the sonographic aspect is greatly influenced by the direction of the ultrasonic beam.
In addition the combination of the reflection and the refraction of the wave can induce multiple rebounds between the probe and the interface creating phantom echoes behind the interface that are called “repetitive echoes,” whereby the echoes are trapped between two reflective interfaces before returning to the sonographic probe.
b) Attenuation
Attenuation is the loss of intensity of the sonographic signal based on the depth of the penetration of tissues and their compositions. The sonograph will automatically compensate for this reduction by amplifying the signal that is received so as to cancel the attenuation that the ultrasonic wave would have undergone if it had passed through only wet tissues. In the case where the tissues that have been passed through by the ultrasonographic beam do not have the attenuation characteristics of wet tissues there is either a reinforcement (this happens with a liquid which will have a lower attenuation power than that of the wet tissues) or the appearance of shadow copies (this happens with bone or gas, which will have more attenuating power than that of the wet tissues).
Nevertheless the attenuation of the signal can be compensated on v up to a certain limit from which the signal is not significant enough relative to the noise. For different frequencies the table below indicates the maximum exploration depth of the ultrasound.
c) Dispersion
In the sonographic images the heterogeneous media are shown by dispersion echoes. The echogenicity (the capacity to generate echoes) of the parenchymatous organs for example is essentially formed by dispersion echoes whose intensity depends on the tissue homogeneity (see accompanying FIGS. 2A and 2B).
In conclusion, it turns out that the signal processing carried out by the computer of a sonograph, so as to construct real ultrasonic images rests on a certain number of hypotheses:

    
    
        1) The direction of the ultrasonic beam is unique
        2) There are not multiple reflections
        3) The absorption of the medium is equivalent to that of the wet tissues
        4) The propagation speed of a wave amounts to 1540 m/s. When one or more of these hypotheses are false parasitic echoes which do not correspond to a real structure appear in the image; these are artifacts. The base information of a sonographic image thereby rests on the properties of reflection, refraction, attenuation and dispersion of tissues. By taking into account these different effects the ultrasonic image is reconstituted from information collected by the probe and transmitted to the device. The data are processed by complex software that makes it possible to determine the position and the intensity of the echo and to display the image (or the signal), or interpretation by the operator.
    
    


Finally the sonographic image can be shown according to several modes:

    
    
        The first mode is the most primitive image representation mode. It consists in displaying the signal amplitude collected by the probe based on the depth (FIG. 3B). A single ultrasonic beam of constant direction is used (FIG. 3A). This mode was formerly used iii pediatric neurology and in ophthalmology.
        The second brightness mode is the most common display mode. It is a matter of showing the intensity of the signal no longer by a curve but by the brightness of a point on the screen. The brighter the point, the greater the reflection of the ultrasound and therefore the more intense the echo (see accompanying FIGS. 4A and 4B).
    
    


When several ultrasonic beams that are parallel to one another are used (linear probe) or when the same ultrasonic beam is oriented in different directions (sector probe), an image is obtained in 2 (two) dimensions (two dimensional) that shows a section of the explored structure (see accompanying FIGS. 5A and 5B).
The inventors however, noted that the elementary principle of a sonographic image is complementary to that of a CT image. Actually, in the case of sonography, it is a matter of processing a signal that returns to the emission source after having passed through the medium under consideration at least twice whereas in the CT imaging, the signal that passes through the medium once is processed. The primary differences therefore rest essentially on the nature of the signal that is an acoustic wave for sonography and an x-ray in the CT image.
Starting from the surprising report given by the inventors of the similarity of densities of the voxels of a CT image with the acoustic impedance of tissues shown in this same data volume, the invention essentially consists in reproducing by simulation, from a CT image, a sonographic image that reproduces all of the effects of attenuation, reflection, refraction and dispersion.
By way of examples, the table below indicates, for different media, the propagation speed of the ultrasound in their midst and their density in the CT image.



BRIEF DESCRIPTION OF THE DRAWING FIGURES
FIG. 1 illustrates the refraction phenomenon in connection with an ultrasonic wave;
FIG. 2A and 2B illustrate the phenomenon of dispersion in connection with an ultrasonic wave;
FIG. 3A and 3B illustrate the use of a single beam sonographic probe and the collected signal, according to a first mode;
FIG. 4A and 4B illustrate the use of a single beam sonographic probe and the collected signal, according to a second mode;
FIG. 5A and 5B illustrate the use of a multiple beam sonographic probe and the collected signal, according to an alternative embodiment;
FIG. 6 is a flow chart type representation of the algorithm underlaying the process, according to the invention; and
FIG. 7 illustrates schematically a simulator for implementing the process according to the invention.



DESCRIPTION OF THE PREFERRED EMBODIMENTS
The invention consists more specifically in reproducing two-dimensional images (showing one or more sonographic planes) by simulating several ultrasonic beams that are emitted from a virtual probe that can be controlled in position and in orientation and positioned in the volume of the CT medical image.
The primary advantage of the process that is implemented by the invention thus rests on the non-necessity of carrying out an initial segmentation of the organs to create a sonographic image from a CT image without pretreatment and in real time. Thus, the invention has as its object a process for simulation or for digital synthesis of sonographic images, characterized by the direct transformation in real time, or quasi-real time, of information contained in a 3D-scanographic (or tomodensitometric)-type medical or veterinary image, without delimitation or segmentation of the organs or structures that are contained in the scanographic volume of data, according to one or more two-dimensional observation windows that can be modified in real time, or quasi-real time, in dimension, in position, in direction and in orientation, whose characteristics are based on the type of a determined virtual sonographic probe and that reproduces all of the effects of attenuation, reflection, refraction and dispersion and effects of adjusting a real sonographic image, whereby each sonographic image that is provided accumulates the results of the simulations of the above-mentioned effects.
According to a first characteristic of the invention, the process advantageously carries out the simulation of two-dimensional sonographic images of which the observation window is obtained by the simulation of several ultrasonic beams, oriented parallel to one another in the manner of a linear probe or oriented in various divergent directions as in the case of a sector probe, corresponding to a set of straight segments that originate from a virtual source characterizing the shape, the direction, the orientation and the dimension of the virtual probe, and whose modifiable length makes it possible to simulate the frequency of the ultrasound by determining the maximum exploration depth.
In the data volume forming the three-dimensional CT image, a flat section is thus produced, whereby data are acquired that are contained in the portion of the plane defined by the above-mentioned straight segments or by means of data located on both sides of said plane portion (in the case of absence of data on said plane portion), so as to obtain a two-dimensional data matrix extracted from said 3D CT image.
According to a possible development of the invention, it may also be provided that the process carries out the simulation of three-dimensional sonographic images defined by several two-dimensional observation windows that are simulated and oriented with differential offsets relative to the position and the orientation of the virtual probe, either around its axis, whereby each window is then characterized by a different angle around the median axis of this probe, or at the end of this probe, whereby each window is then characterized by a different angle around the perpendicular axis in the plane of observation of this probe. According to the invention, the process preferably consists in creating one or more window(s) or space(s) for analysis for the simulation of two-dimensional or three-dimensional sonographic images, window(s) or space(s) defined by the plane or the volume in which a virtual acoustic wave that is simulated by a set of straight segments originates at the virtual sonographic probe and ultimately represents a rectangle, a partial disk, a tube or a spherical portion centered on the origin of the probe, whereby this volume varies based on the degree of precision of the final simulation of the sonographic image.
The process advantageously comprises the simulation of the effects of dispersing ultrasound via the structures that are passed through and that are present in a real sonographic image, whereby this simulation results in the creation of an absorption image that is limited to the observation window that is defined above, obtained by transformation of the densities d contained in the scanographic image that is limited to the analysis window or to space that is also defined above, at the gray level l(d) of a sonographic image, by the definition and the application of a transfer function/simulating the orders of magnitudes of the acoustic impedance values of the strictures that are passed through, whereby said function may or may not be continuous, or may or may not be linear according to the methods, the type and the characteristics of the initial scanographic image. In addition, the process advantageously comprises the simulation of the effects of reflection, refraction and attenuation of the ultrasound by the interfaces that are passed through and that are present in a real sonographic image, whereby this simulation results in the creation, on the one hand, of an attenuation image that simulates the effects of sonographic shadows and the effects of sonographic reinforcements that are visible respectively beyond an interface between a wet tissue or a liquid and air or bone, and beyond an interface between a liquid and a soft tissue, and, on the other hand, an image or mask of multiple echoes, simulating the effects of reverberation of an ultrasonic echo inside a bone that is visible beyond an interface between a soft tissue or a liquid and bone, whereby these images are both limited to the observation window defined above and are obtained along trajectories of ray tracings that are oriented (defining the above-mentioned window or windows or space(s) for analysis)) by the detection in real-time of interfaces that are calculated by thresholding, gradient and/or filtering techniques of the densities of the initial scanographic image that is limited to the analysis window or to space that is defined according to claim 4.
In addition, the process advantageously comprises the simulation of dispersion noises that the ultrasound experiences in the tissues through which it passes or the effects of these noises. This simulation results in the creation of an image that is limited to the observation window that is defined above, simulating the effects of refraction and dispersion in a sonographic image, obtained by the calculation of the effects of refraction and dispersion of the tissues through which the simulated sonographic wave, described above, passes, whereby this simulation is carried out either by defining a general noise in the image or by simulating more specifically the above-mentioned effects by detecting and characterizing the interfaces between the various structures of the analysis window through which the sound passes. Finally, the process advantageously comprises the simulation of the effects of adjusting the virtual or simulated sonographic probe, resulting in the creation of an image or mask for limited adjustment to the observation window defined above and simulating the adjustments of luminosity, contrast, gain or any other adjustable parameter of the virtual or simulated sonographic probe as defined above.
Preferably, the process according to the invention carries out the creation of a limited sonographic image, with the observation window defined above, and accumulates the results of four different simulations that are described above. As the foregoing indicates, the principle at the base of this invention consists, to produce sonographic images for synthesis, in using directly three-dimensional scanographic images, preferably with great precision, without carrying out a cumbersome pretreatment phase that requires a significant amount of time and processing power.
To optimize the calculation of the sonographic image for synthesis, the propagation of the ultrasound is modeled as a one-dimensional phenomenon.
To this end, a first stage of the process consists in carrying out a tracing of three-dimensional rays directly in the three-dimensional scanographic image so as to collect all of the voxels that are located in the plan for investigation of the simulated virtual probe. Each possible propagation direction for the ultrasonic wave corresponds to a line of the resulting two-dimensional image. This image is then analyzed for the purpose of extracting therefrom two different pieces of information.
On the one hand, the acoustic behavior of each pixel is estimated, and, on the other hand, interfaces that are cut or passed through by the rays (propagation directions) are detected, identified, and marked (wet tissues, bone, gas, liquid, . . . ).
These processing operations can be carried out in an unconnected state, optionally directly in the scanograph.
On the basis of these data, at least three different simulations are carried out, namely a simulation of the reflection effects of the ultrasound by the interfaces that are passed through (reverberation), a simulation of the absorption effects of the ultrasound by the structures that are passed through (attenuation), and a simulation of dispersion effects and a noise matrix.
The first simulation provides a so-called “multiple echoes” image, created by using the knowledge of nature and the position of the interfaces between the organs or the regions of different tissues. Thanks to this image, the multiple echoes are detected and shown.
The second simulation provides an absorption image that shows the accumulation of the absorption characteristics of the materials and substances along the ultrasonic wave.
The third simulation provides the base image or the base texture that is generated by combining, for each pixel, the value that is read into the scanographic image and the information relative to the nature of the tissues in question and its acoustic characteristics. The base image is also made blurry by using a randomly generated noise.
The final simulated sonographic image is the result of the merging or the combination of the three above-mentioned images, limited to an observation window that is determined by the nature and the adjustment of the simulated probe, whereby said resulting image is also applied in a texture before its display.
The invention will be better understood thanks to the description below, which relates to a preferred embodiment, provided by way of nonlimiting example, and explained with reference to the accompanying diagrammatic drawings, in which: FIG. 6 shows, in the form of an algorithm, the primary operating and processing stages carried out by the process according to the invention, and FIG. 7 diagrammatically shows a simulator that implements the process according to the invention.
Taking into consideration the principle of the invention, it is primarily necessary to read the tomodensitometric (CT)-type medical or veterinary image whose data volume will supply the information base that allows the recreation of a virtual sonograph of the observed subject.
From this volume of data, the first module 1 of the algorithm consists in simulating the sonographic probe, i.e., in defining its static properties (2D or 3D probe, linear or sector probe) and its variable properties (position, direction, orientation, frequency of the emitted wave, gain, contrast, etc.). The implementation of this first module 1 is necessary for carrying out the invention that consists in creating a virtual sonographic image from a virtual or simulated probe.
The second module 2 (comprising four submodules 3, 3′, 3′′, 3′′′), which more particularly characterizes the invention, consists in creating the sonographic image that a real sonographic probe would generate, whose parameters are provided by the first module 1, if it were frequency-tuned, localized, directed, oriented and parameterized according to the information that is provided by said first module, on a real subject of which a portion of anatomical characteristics are provided by the CT image. To generate this image, the sonography simulation module 2 consists of, as the accompanying FIG. 6 shows, four primary submodules 3, 3′, 3′′, 3′′′ that respectively carry out the simulation of the dispersion, the reflection, the refraction and the absorption of noises due to the refraction and the dispersion and effects due to the adjustment of the probe, such as the gain or the contrast, for example.
Before simulating these effects, the first stage of the simulation consists in defining the restricted space in which the simulated image will be recreated, as well as the space for analysis that makes it possible to recreate the effects of absorption, reflection, and noises of refraction and dispersion on this image.
In the case of a 2D (two-dimensional) sonographic image, the space of the image will correspond to a limited plane in its dimensions by the dimension of the probe and the frequency of the signal that is emitted. If this is a linear probe, the shape of this space will be a rectangle whose width will be equal to the width of the probe, and the length will depend on the frequency, whereas in the case of a sector probe, the shape of this space will be a disk section whose ray will depend on the frequency.
In the case of a 3D (three-dimensional) sonographic image, the space of the image will actually consist of several 2D spaces of sector or linear type.
The space for analysis corresponds, for its part, to the simulation of the space for propagation and the return to the probe of the ultrasonic waves. It may vary based on a compromise between realism and speed, which the user can define. On a less powerful, computer, it may be possible, for example, to preserve a space for analysis that is equal to the space of the image, but in this case, the tissues that are located outside of the space of the sonographic image cannot influence the image, as may be the case within the case of the refraction in particular. If the computer is more powerful, the broadening of the analysis space thereby will make it possible to improve the simulation while preserving real-time image generation. In absolute terms, it is useless to keep information beyond the maximum distance defined by the frequency of the waves emitted by the probe. The shape of the thus generated space will depend, there again, on the type of probe that is used and will lead either to a spherical portion (2D or 3D linear or sector probe), or to a full cylinder (endoluminal sonographic probe). Whereby these two windows are defined, the first sub-module 3 consists in simulating the dispersion phenomenon by means of tissues that are passed through by the ultrasonic waves. The principle of the invention consists, on this subject, in simulating this phenomenon by transforming the density or each piece of information on density of the CT image into a gray level in the sonographic image. To carry out this transformation, a transfer function that transforms a density d in the image CT into an intensity: Isonographiqu(d) in the sonographic image is defined. This function can vary according to the desired level of realism based on the characteristics of the CT acquisition. If the CT image is produced without injection of contrast product, a monotone function will be adequate: IsonographMque(d)=coef*d. In contrast, if the CT image is produced with injection of a contrast product, which modifies the intrinsic characteristics of the tissues, it will be necessary to define a more complex transfer function that corrects the contrasting of tissues that are normally darker in the CT image. Whereby the contrast is present essentially in the vessels and the vascularized wet tissues, the correction may consist in, for example reversing the direction of variation of the transfer operation from 80 HU, classic value of the most radio-opaque wet tissues, up to 200 HU, standard value of the most contrasted tissues by the contrast product, then to resume the initial meaning beyond this latter value. Obviously, such a function would bring about errors on certain values, but this remains true for any transfer function that could only attempt to simulate the real effect of the dispersion without ever being able to equal it, since, physically, the density of a CT image and the dispersion of ultrasonic waves remain two close—but physically uncorrelated—phenomena. Regardless of the level of precision of the transfer function, the approximations that it entrains call in all cases be reduced by the other effects of reflection, refraction or else attenuation. The final result of this first sub-module is the definition of a first image, corresponding to a sonographic window for visualization of gray without effect.
The second sub-module 3′ has as its objective to simulate the phenomena of reflection, retraction and attenuation of interfaces that generate multiple echoes and the attenuation mask. The principle of the invention consists, on this subject in simulating these phenomena that are oriented and directed based on parameters of the probe, i.e., limited to the visualization window, then to calculate the reflections of this ray that is based on the variations of the densities of the CT image that makes it possible to approach the variations of the impedances of tissues that were passed through. The definition of these interfaces can be carried out in several ways: either, for example, by calculating the gradient of the initial CT image, or by calculating the gradient of the initial CT image that is modified by a transfer function that is equal to or different from the transfer functions that is defined in the first sub-module, or by any other method that makes it possible to end in a similar result.
Whereby the interfaces are defined, the shadow phenomenon will appear when the interface becomes too large, i.e., when the impedance difference of two adjacent tissues is too large. To simulate correctly the shadow effect, it is necessary to pick up the orders of magnitudes of the reflection coefficients in normal incidence that are defined in a sonographic image. These coefficients show that a dark shadow will be obtained in the case of an interface between air and water or a wet tissue, and that a medium shadow will be obtained in the case of an interface between bone and water or a wet tissue. Air and bones are at two ends of the densities of a CT image, whereas water and wet tissues, even contrasted, are located in the median values of the densities of a CT image. The principle of the invention thereby will consist in creating—along the ray—a strong attenuation of the densities beyond an interface that is detected if the interface consists of very low values in the CT image (corresponding to air) and in creating—along the trace of each ray—a median attenuation of the densities beyond a detected interface if the interface consists of high values in the CT image (corresponding to the bone or to a radio-opaque element). To characterize this attenuation, the simulation of this shadow will end in an image called an attenuation mask, limited to the visualization window and whose real values will be between 0 and 1 so as to be able to multiply the by the value of the absorption window. The attenuation of the gray levels of the final image will therefore be obtained by multiplying the initial values by the attenuation value.
Some interfaces can trigger different attenuation effects that are characterized by reinforcement. The reinforcement is a phenomenon for increasing gray levels in the direction of emitted ultrasonic waves that pass through a liquid. It can easily be reflected by a slight increase of densities beyond a detected interface if the interface is composed of densities that are close to 0 in a CT image (value corresponding to water). To characterize this increase the simulation of this reinforcement will consist in defining values of more than 1 in the reflection mask. The important interfaces can finally create an effect that is called a multiple echo and that corresponds to a replication of an interface in depth in the same axis of the rays that have defined the interface between a wet tissue or water and bones or a solid element. The principle of the invention will thereby consist in creating a replication of the interface beyond a detected interface if this interface consists of high densities in the CT image (corresponding to bone or to a radio-opaque element) along the axis of each ray trajectory. To characterize this replication, the simulation of this multiple echo via the ray trajectory will end in an image, called a multiple-echo window, limited to the visualization window and whose values will make it possible to display the replications of the interface by increasing the gray levels of the sonographic image. It can therefore be a matter of a mask whose pixel value will be multiplied by the value of the gray levels of the absorption window or else an image whose gray level value will be added to the gray level value of the absorption window.
The purpose of the third sub-module 3′′ is to simulate the phenomena of dispersion noises. On this subject, the principle of the invention consists in simulating these phenomena by defining an image that will make it possible to modify the value of the gray levels of the absorption window. The simulation of these phenomena is without doubt the most complex since they are not taken into account by the reconstruction software of a real sonographic image and are thus characterized as a noise. Several methods could then be used based on a compromise between the realism of the effect, and the processing time to carry it out. The most simple method consists in calculating a random noise that reproduces a texture that is comparable to the noise that is observed in the sonographic images. A Gaussian noise that is oriented normal to the rays thus provides a first simple and rapid approximation of such a noise in real time.
The result of the third sub-module 3′′ ultimately will be an image or a mask that makes it possible to modify the intensities of the absorption image.
The fourth sub-module 3′′′ has as its objective to simulate the adjustment parameters of the image provided by the sonographic probe. On this subject, the principle of the invention consists in simulating these adjustments that generally correspond to contrast, to luminosity or else to more or less complex gain functions, by a mask that makes it possible to modify the simulated sonographic image. These standard functions will therefore be translated into an image, called an image adjustment mask, which is limited to the visualization window and whose real values will be between 0 and n so as to be able to multiply them by the value of the simulated sonographic image.
Ultimately, by combining all of the images that are obtained by each of these sub-modules 3, 3′, 3′′, 3′′′ (the second sub-unit 3′′ able to provide two of them as FIG. 6 of the drawings shows), either by adding the gray levels of these images or by multiplying them according to a function that can vary according of the specific definition of each of these images (mask multiplication, image addition), the principle of the invention consists in providing a simulated sonographic image that picks up and integrates each of the effects and adjustments of a real sonographic image. A more detailed description of a practical and concrete embodiment of the process and the system according to the invention, in particular on the level of modules and sub-modules of the algorithm, is not necessary, whereby one skilled in the art is easily able, from characteristics described above and shown in the accompanying figures, to reproduce such an embodiment. This invention also has as its object, as FIG. 7 of the accompanying drawings shows diagrammatically, a system 4 for simulation or digital synthesis of sonographic images or a real-time or quasi-real time sonographic simulator, comprising at least one computer processing unit 5 with memory, a screen 6 for visualizing (an) image(s) and at least one means 7 for control and programming for a user. This simulator is characterized in that it uses the process for simulation or synthesis of digital images described above and in that said at least one means 7 for control and programming is at least able to indicate to the processing unit 5 the type of virtual sonographic probe to simulate as well as, in real time or quasi-real time, the different parameters for adjusting and handling this probe by the user, and optionally the 3D scanographic-type medical or veterinary image that is selected by the user from among several available images.
Advantageously said at least one means 7 for control and programming comprises a force or stress feedback interface making it possible to simulate the positioning characteristics of the probe relative to the virtual subject. Such interfaces are perfectly known to one skilled in the art.
Of course, the invention is not limited to the embodiment that is described and shown in the accompanying drawings. Modifications remain possible, in particular from the viewpoint of the constitution of the various elements or by substitution of equivalent techniques, without thereby exceeding the scope of protection of the invention. In particular, the processing assigned at each of the sub-modules of the second module optionally can be replaced by different alternative kinds of processing that lead to similar or identical results, for example with a single image.
In addition as indicated above the process according to the invention can be applied as much to the simulation of two-dimensional sonographic images as to three-dimensional sonographic images (reconstructed from two-dimensional images).

## Claims

1. A process for simulation or for digital synthesis of sonographic images, comprising:
using a sonographic simulator comprised of a computer processing unit with memory and control means serving as a determined virtual sonographic probe, performing simulations by direct transformation in real time, or quasi-real time, of information contained in a 3D-scanographic image having organs contained in a scanographic volume of data, without delimitation or segmentation of the organs contained in the scanographic volume of data,
the direct transformation according to one or more two-dimensional observation windows i) that can be modified in real time, or quasi-real time, in dimension, in position, in direction and in orientation, whose characteristics are based on the determined virtual sonographic probe and ii) that reproduce all effects of attenuation, reflection, refraction and dispersion and effects of adjusting a real sonographic image,
wherein each sonographic image accumulates results of the performed simulations of the effects of attenuation, reflection, refraction and dispersion and the effects of adjusting the real sonographic image.

2. The process according to claim 1, characterized by the simulation of two-dimensional sonographic images whose observation window is obtained by the simulation of several ultrasonic beams, oriented parallel to one another in the manner of a linear probe or oriented in various divergent directions in the manner of a sector probe, corresponding to a set of straight segments that originate from a virtual source characterizing the shape, the direction, the orientation and the dimension of the virtual probe and whose modifiable length makes it possible to simulate the frequency of the ultrasound by determining the maximum exploration depth.

3. The process according to claim 2, characterized by the simulation of three-dimensional sonographic images defined by several two-dimensional observation windows that are simulated and oriented with differential offsets relative to the position and the orientation of the virtual probe, either around its axis, whereby each window is then characterized by a different angle around the median axis of this probe, or at the end of this probe, whereby each window is then characterized by a different angle around the axis that is perpendicular to the plane of observation of this probe.

4. The process according to claim 2, characterized by the creation of one or more analysis windows or spaces for the simulation of two-dimensional or three-dimensional sonographic images, defined by the plane or the volume in which a virtual acoustic wave that is simulated by a set of straight segments originates at the virtual sonographic probe and ultimately represents a rectangle, a partial disk, a tube or a spherical portion centered on the origin of the probe, whereby this volume varies based on the degree of precision of the final simulation of the sonographic image.

5. Process according to claim 4, characterized by the simulation of the effects of dispersing ultrasound via the structures that are passed through and that are present in a real sonographic image, whereby this simulation results in the creation of an absorption image that is limited to the observation window, obtained by transformation of the densities (d) contained in the scanographic image that is limited to the analysis window or to the space, at the gray level 1(d) of a sonographic image, by the definition and the application of a transfer function (l) simulating the orders of magnitudes of the acoustic impedance values of the structures that are passed through, whereby said function (l) may or may not be continuous, or may or may not be linear according to the methods, the type and the characteristics of the initial scanographic image.

6. The process according to claim 4, characterized by the simulation of the effects of reflection, refraction and attenuation of the ultrasound by the interfaces that are passed through and that are present in a real sonographic image, whereby this simulation results in the creation, on the one hand, of an attenuation image that simulates the effects of sonographic shadows and the effects of sonographic reinforcements that are visible respectively beyond an interface between a wet tissue or a liquid and air or bone, and beyond an interface between a liquid and a wet tissue, and, on the other hand, an image or mask of multiple echoes, simulating the effects of reverberation of an ultrasonic echo inside a bone that is visible beyond an interface between a wet tissue or a liquid and bone, whereby these images are both limited to the observation window and obtained along the trajectories of ray tracings by the detection in real time of interfaces that are calculated by thresholding, gradient and/or filtering techniques of the densities of the initial scanographic image that is limited to the analysis window or to the space.)

7. The process according to claim 4, characterized by the simulation of the dispersion noises that the ultrasound experiences in the tissues through which it passes or, if necessary, the effects of these noises, whereby this simulation results in the creation of an image that is limited to the observation window, simulating the effects of refraction and dispersion in a sonographic image, obtained by the calculation of the effects of refraction and dispersion of the tissues through which the simulated sonographic wave, passes, whereby this simulation is carried out either by defining a general noise in the image or by simulating more specifically the above-mentioned effects by detecting and characterizing the interfaces between the different structures of the analysis window through which the sound passes.

8. The process according to claim 4, characterized by the simulation of the effects of adjusting the virtual or simulated sonographic probe, resulting in the creation of an image or mask for limited adjustment to the observation window simulating the adjustments of luminosity, contrast, gain or any other adjustable parameter of the virtual or simulated sonographic probe.

9. The process according to claim 5, characterized by the creation of a sonographic image that is limited to the observation window that accumulates the results of the simulations.

10. The process according to claim 3, characterized by the creation of one or more analysis windows or spaces for the simulation of two-dimensional or three-dimensional sonographic images, defined by the plane or the volume in which a virtual acoustic wave that is simulated by a set of straight segments originates at the virtual sonographic probe and ultimately represents a rectangle, a partial disk, a tube or a spherical portion centered on the origin of the probe, whereby this volume varies based on the degree of precision of the final simulation of the sonographic image.

11. The process according to claim 6, characterized by the creation of a sonographic image that is limited to the observation window and that accumulates the results of the simulations.

12. The process according to claim 7, characterized by the creation of a sonographic image that is limited to the observation window and that accumulates the results of the simulations.

13. The process according to claim 8, characterized by the creation of a sonographic image that is limited to the observation window and that accumulates the results of the simulations.