Patent Description:
Contrast enhanced ultrasound (CEUS) is an ultrasound imaging technique used in a variety of clinical applications. CEUS can detect the nonlinear signals received from microbubbles which circulate in the blood stream after an intravenous injection of an ultrasound contrast agent. As such CEUS imaging allows for documentation of tissue perfusion due to comparatively slow flow at the capillary level, as well as visualizing blood flow in arteries and veins. As a result, CEUS is capable at providing dynamic visualization of blood flow at both the macro- and micro-circulation levels. Among other clinical applications, CEUS imaging mode is recommended in the diagnosis and treatment of lesions on the liver, which may be malignant.

A sonographer typically operates a probe to gather images and loops that can span a few minutes. The representative images and loops gathered by the sonographer are often then sent to another location for review of the data by a radiologist or other trained clinician, for example. In some cases, a radiologist/clinician performs the sonogram, gathering/evaluating frames and loops used in diagnosis and treatment of medical condition. Moreover, radiologists/clinicians typically review cases in a remote workstation without being present during the CEUS exam which is the case at the radiology department in USA. So, the data from the procedure must be stored and transmitted from the location of the sonographer to the radiologist/clinician. This data transfer can be challenging due to the comparatively long duration of the acquired CEUS sequences.

During a CEUS procedure, scans are often taken in a two-dimensional plane through the portion of the body (e.g., the liver) being examined. A large number of frames and loops are gathered during the procedure and are sent for review by a trained clinician such as a radiologist/clinician. As will be appreciated, when a sonographer is taking a scan of a region of interest (ROI), there are many sources of movement that can impact the quality of the images being gathered. For example, movement of the patient due to breathing can result in a shift in the location of the image plane, resulting images out of the image plane of the current scan, and ultimately in images lesser quality and unproductive scans.

While some types of motion compensation are used to reduce the impact of the respiratory motion on the images being gathered, motion artifacts in the form of out-of-plane images remain when using known advanced CEUS imaging systems. Of the comparatively large amount of image data gathered in a scan, much of the data can be out-of-plane and of undesirable quality due to motion during a CEUS scan. These data are often stored in memory and are transmitted to the clinician for reviewing. As will be appreciated, more stored data or transmitted data, or both, places a burden on the computer system used to store, transmit and share the image data from the scan. These large amounts out-of-plane image data, which are of lesser quality and thus not useful to the clinician reviewing the images, are stored in ever-scarce memory. Moreover, the clinician reviewing the scans from a CEUS procedure has to sort through many images to find the images of sufficient quality to properly assess the patient's condition. As such, not only are out-of-plane image data a drain on memory resources, but also they occupy the clinician's time during review of the CEUS procedure.

The publication <CIT> discloses detecting out-of-plane frames by detecting decreases in correlation values, including normalized auto correlation values. The further publication by <NPL>, relates to motion correction based on a local maximum normalized correlation coefficient.

What is needed is a system that overcomes at least the noted drawbacks of known systems set forth above.

According to an embodiment of the present disclosure, a system for providing contrast enhanced ultrasound (CEUS) images comprises: an ultrasound probe adapted to provide the ultrasound images; a processor; a tangible, non-transitory computer-readable medium that stores instructions, which when executed by the processor causes the processor to: generate time-intensity-curves for the ultrasound images; determine, based on the time-intensity-curves, out-of-plane frames of the ultrasound images; remove the out-of-plane frames from the ultrasound images based on a criterion to provide an optimized set of frames; and a display in communication with the processor and configured to display the optimized set of frames.

According to another embodiment of the present disclosure, a tangible, non-transitory computer-readable medium stores instructions, which when executed by a processor, cause the processor to: generate time-intensity-curves for the ultrasound images; determine, based on the time-intensity-curves, out-of-plane frames of contrast enhanced ultrasound images (CEUS); remove the out-of-plane frames from ultrasound images based on a criterion to provide an optimized set of frames; and a display in communication with the processor and configured to display the optimized set of frames.

According to another embodiment of the present disclosure, a method of providing ultrasound images is disclosed. In particular, the method discloses: generating time-intensity-curves for the ultrasound images; determining, based on the time-intensity-curves, out-of-plane frames of the ultrasound images; removing the out-of-plane frames from the ultrasound images based on a criterion to provide an optimized set of frames; and displaying the optimized set of frames.

The representative embodiments are best understood from the following detailed description when read with the accompanying drawing figures. It is emphasized that the various features are not necessarily drawn to scale. In fact, the dimensions may be arbitrarily increased or decreased for clarity of discussion. Wherever applicable and practical, like reference numerals refer to like elements.

In the following detailed description, for the purposes of explanation and not limitation, representative embodiments disclosing specific details are set forth in order to provide a thorough understanding of an embodiment according to the present teachings. Descriptions of known systems, devices, materials, methods of operation and methods of manufacture may be omitted so as to avoid obscuring the description of the representative embodiments. Nonetheless, systems, devices, materials and methods that are within the purview of one of ordinary skill in the art are within the scope of the present teachings and may be used in accordance with the representative embodiments. It is to be understood that the terminology used herein is for purposes of describing particular embodiments only and is not intended to be limiting. The defined terms are in addition to the technical and scientific meanings of the defined terms as commonly understood and accepted in the technical field of the present teachings.

It will be understood that, although the terms first, second, third, etc. may be used herein to describe various elements or components, these elements or components should not be limited by these terms. These terms are only used to distinguish one element or component from another element or component. Thus, a first element or component discussed below could be termed a second element or component without departing from the teachings of the inventive concept.

The terminology used herein is for purposes of describing particular embodiments only and is not intended to be limiting. As used in the specification and appended claims, the singular forms of terms "a," "an" and "the" are intended to include both singular and plural forms, unless the context clearly dictates otherwise. Additionally, the terms "comprises," "comprising," and/or similar terms specify the presence of stated features, elements, and/or components, but do not preclude the presence or addition of one or more other features, elements, components, and/or groups thereof.

As described more fully below, the present teachings relate to a CEUS system, method and tangible, non-transitory computer readable medium that provide a contrast enhanced ultrasound (CEUS) workflow with representative short, limited numbers of frames, or loop selections, or both. Among other benefits, the workflow according to the present teachings reduces the time and effort needed for the review procedure since <NUM>) a necessary subset of representative images with TIC (time intensity-curve) curves as well as two pre-contrast B-mode images are transferred to the workstation; and <NUM>) the radiologist's or other trained clinician's effort is concentrated in reviewing comparatively smaller datasets containing essential diagnostic information, which is automatically abstracted from the entire CEUS cine-loop (cinematic loop). This novel CEUS workflow will simplify and facilitate the CEUS image acquisition and interpretation efforts. As such, the CEUS system, method and tangible, non-transitory computer readable medium that provide a CEUS workflow provide a beneficial practical application and improvements in this and potentially other technical fields.

<FIG> is a simplified block diagram of an imaging system <NUM> for imaging a region of interest of a subject, according to a representative embodiment.

Referring to <FIG>, the imaging system <NUM> comprises an imaging device <NUM> and a computer system <NUM> for controlling imaging of a region of interest in a patient <NUM> on a table <NUM>. The imaging device <NUM> is illustratively an ultrasound imaging system capable of providing a contrast enhanced ultrasound (CEUS) image scan of a region of interest (ROI) of the patient <NUM>.

The computer system <NUM> receives image data from the imaging device <NUM>, and stores and processes the imaging data according to representative embodiments described herein. The computer system <NUM> comprises a controller or processor <NUM>, a memory <NUM>, a display <NUM> comprising a graphical user interface (GUI) <NUM>, and a user interface <NUM>. The display <NUM> may also include a loudspeaker (not shown) to provide audible feedback.

The memory <NUM> stores instructions executable by the controller <NUM>. When executed, and as described more fully below, the instructions cause the controller <NUM> to allow the user to perform different steps using the GUI <NUM> or the user interface <NUM>, or both, and, among other tasks, to initialize an ultrasound imaging device comprising a transducer. In addition, the controller <NUM> may implement additional operations based on executing instructions, such as instructing or otherwise communicating with another element of the computer system <NUM>, including the memory <NUM> and the display <NUM>, to perform one or more of the above-noted processes.

The memory <NUM> may include a main memory and/or a static memory, where such memories may communicate with each other and the controller <NUM> via one or more buses. The memory <NUM> stores instructions used to implement some or all aspects of methods and processes described herein.

As will become clearer as the present description continues, the instructions stored in memory <NUM> may be referred to as "modules," with different modules comprising executable instructions, which when executed by a processor, carry out the various functions described in connection with various representative embodiments described below. These modules include but are not limited to a module to automatically identify out-of-plane (OOP) frames and loops, and remove them, and a module to select representative frames and short loops of images for storing, or transmission to a radiologist or other clinician for review.

The memory <NUM> may be implemented by any number, type and combination of random-access memory (RAM) and read-only memory (ROM), for example, and may store various types of information, such as software algorithms, which serves as instructions, which when executed by a processor cause the processor to perform various steps and methods according to the present teachings. Furthermore, updates to the methods and processes described herein may also be provided to the computer system <NUM> and stored in memory <NUM>.

The various types of ROM and RAM may include any number, type and combination of computer readable storage media, such as a disk drive, flash memory, an electrically programmable read-only memory (EPROM), an electrically erasable and programmable read only memory (EEPROM), registers, a hard disk, a removable disk, tape, compact disk read only memory (CD-ROM), digital versatile disk (DVD), floppy disk, Blu-ray disk, a universal serial bus (USB) drive, or any other form of storage medium known in the art. The memory <NUM> is a tangible storage medium for storing data and executable software instructions, and is non-transitory during the time software instructions are stored therein. As used herein, the term "non-transitory" is to be interpreted not as an eternal characteristic of a state, but as a characteristic of a state that will last for a period. The term "non-transitory" specifically disavows fleeting characteristics such as characteristics of a carrier wave or signal or other forms that exist only transitorily in any place at any time. The memory <NUM> may store software instructions and/or computer readable code that enable performance of various functions. The memory <NUM> may be secure and/or encrypted, or unsecure and/or unencrypted.

"Memory" is an example of computer-readable storage media, and should be interpreted as possibly being multiple memories or databases. The memory or database for instance may be multiple memories or databases local to the computer, and/or distributed amongst multiple computer systems or computing devices, or disposed in the 'cloud' according to known components and methods. Examples of computer readable storage media include non-transitory media such as computer memory devices that store information in a format that is readable by a computer or data processing system. More specific examples of non-transitory media include computer disks and non-volatile memories.

The processor or controller <NUM> is representative of one or more processing devices, and is configured to execute software instructions stored in memory <NUM> to perform functions as described in the various embodiments herein. The controller <NUM> may be implemented by field programmable gate arrays (FPGAs), application specific integrated circuits (ASICs), systems on a chip (SOC), a general-purpose computer, a central processing unit, a computer processor, a microprocessor, a graphics processing unit (GPU), a microcontroller, a state machine, programmable logic device, or combinations thereof, using any combination of hardware, software, firmware, hard-wired logic circuits, or combinations thereof. Additionally, any processing unit or processor herein may include multiple processors, parallel processors, or both. Multiple processors may be included in, or coupled to, a single device or multiple devices.

The term "processor" as used herein encompasses an electronic component able to execute a program or machine executable instruction. References to a computing device comprising "a processor" should be interpreted to include more than one processor or processing core, as in a multi-core processor. A processor may also refer to a collection of processors within a single computer system or distributed among multiple computer systems, such as in a cloud-based or other multi-site application. The term computing device should also be interpreted to include a collection or network of computing devices each including a processor or processors. Modules have software instructions to carry out the various functions using one or multiple processors that may be within the same computing device or which may be distributed across multiple computing devices.

The display <NUM> may be a monitor such as a computer monitor, a television, a liquid crystal display (LCD), a light emitting diode (LED) display, a flat panel display, a solid-state display, or a cathode ray tube (CRT) display, or an electronic whiteboard, for example. The display <NUM> may also provide a graphical user interface (GUI) <NUM> for displaying and receiving information to and from the user.

The user interface <NUM> may include a user and/or network interface for providing information and data output by the controller <NUM> and/or the memory <NUM> to the user and/or for receiving information and data input by the user. That is, the user interface <NUM> enables the user to operate the imaging device as described herein, and to schedule, control or manipulate aspects of the imaging system <NUM> of the present teachings. Notably, the user interface <NUM> enables the controller <NUM> to indicate the effects of the user's control or manipulation. The user interface <NUM> may include one or more of ports, disk drives, wireless antennas, or other types of receiver circuitry. The user interface <NUM> may further connect one or more interface devices, such as a mouse, a keyboard, a mouse, a trackball, a joystick, a microphone, a video camera, a touchpad, a touchscreen, voice or gesture recognition captured by a microphone or video camera, for example.

Notably, the controller <NUM>, the memory <NUM>, the display <NUM>, the GUI <NUM> and the user interface <NUM> may be located away from (e.g., in another location of a building, or another building) the imaging device <NUM> operated by a sonographer. The controller <NUM>, the memory <NUM>, the display <NUM>, the GUI <NUM> and the user interface <NUM> may be, for example, located where the radiologist/clinician is located. Notably, however, additional controllers, the memories, displays, GUI and user interfaces may be located near the sonographer and are useful in effecting the various functions of the imaging device <NUM> needed to complete the CEUS scans contemplated by the present teachings.

<FIG> is a flow chart of a method <NUM> of collecting images using the CEUS imaging system of <FIG> to provide frames of images for a clinician for review according to a representative embodiment. Various aspects and details of the method are common to those described in connection with representative embodiments of <FIG>. These common aspects and details may not be repeated to avoid obscuring the presently described representative embodiment.

Referring to <FIG>, an initial plane for imaging the liver is selected at <NUM> and a CEUS image is acquired at the initial plane at <NUM>. That is, at <NUM> the sonographer begins a CEUS scan at an initial location, such as at a lesion on the liver. In performing the scan, the imaging device <NUM> captures an image of a two-dimensional image plane (sometimes referred to as a slice), which is the initial plane, and acquiring a CEUS image is at the initial plane. The initial plane is located at a portion of the body selected for imaging, which for illustrative purposes may be a targeted lesion region at the middle of the ultrasound image. The CEUS image is acquired by putting the probe at a suitable position/orientation, then collecting incoming frames over the entire examination period of <NUM> to <NUM> minutes. As used herein and as described more fully below, an image taken in the desired image plane or not too far out of the desired image plane from where the sonographer is attempting to gather image data is referred to as being an in-plane (IP) image and includes the full region for the lesion to be examined, and is desirable for further review to aid in diagnosis or treatment. Notably, these desired in-plane frames may be referred to herein as optimized frames at least because they provide the radiologist/clinician with frames most useful in diagnosing and treating a patient, and do not include OOP frames, which are not only less useful in diagnosis and treatment of a patient, but also, if provided to the radiologist/clinician, may cause the radiologist/clinician to be burdened with reviewing a comparatively large number of less than optimal frames from the CEUS procedure.

However, and as described more fully below, relative movement of the patient and imaging device can cause the imaging device <NUM> to capture an image in another image plane that is not the same as the desired initial plane. For example, when the sonographer is attempting to capture an image at the selected location (e.g., the targeted lesion region), movement of the patient (e.g., caused by breathing) or an unintended movement of the imaging device <NUM> by the sonographer, the imaging device <NUM> will have moved relative to the selected location. This will cause the imaging device <NUM> to capture an ultrasound image from another plane different from initial plane. By contrast in a desired IP image, based on certain factors discussed more fully below, the image taken at another plane that is too far from the initial plane is referred to herein as being an OOP image, and is not desirable. According to various aspects of the present teachings described in connection with representative embodiments below, OOP images that are deemed too far out of the initial plane are and are not included in the images provided for review by a radiologist or similarly trained clinician. By one measure, in an OOP a significant portion (e.g., <NUM>%-<NUM>%) of the targeted region for the lesion is lost in the current image frame.

After completion of <NUM>, the method <NUM> proceeds to <NUM> for performing a visual cine-loop quality check. For example, the sonographer may review the images acquired in <NUM> to check the quality of the images gathered (e.g., in the <NUM>-<NUM> minute portion of the procedure as alluded to above).

At <NUM>, the sonographer determines if the image data acquired is sufficient for a complete review and analysis of the condition of the anatomy being imaged. When the sonographer determines that enough image data have been acquired, the method <NUM> proceeds to <NUM> where the collected data are stored, or transmitted to another location for storage and review, or both.

When the sonographer determines that more image data is required, the method <NUM> continues at <NUM>. Here a second contrast agent may be needed for the current plane or the next plane of the liver where the appearance of perfusion is not clear during the first injection period. The method <NUM> then returns to <NUM>, and the procedure is repeated until it the sonographer determines at <NUM> that the image data acquired is sufficient for a complete review and analysis of the condition of the anatomy being imaged. The method <NUM> then proceeds to <NUM> where the collected data are stored, or transmitted to another location for storage and review, or both. As described more fully below, OOP images that are not useful for the desired imaging procedure are removed and not stored at <NUM>. Rather the image data that are stored at <NUM> comprise only images that are beneath a threshold set for OOP images.

<FIG> is a flow chart of a method <NUM> of reviewing all cinematic loops (cine-loops) collected in the method of <FIG> by a radiologist or other trained clinician in accordance with a representative embodiment. Various aspects and details of the method are common to those described in connection with representative embodiments of <FIG> and <FIG>. These common aspects and details may not be repeated to avoid obscuring the presently described representative embodiment.

At <NUM> the entire imaging procedure, including entire cine-loops and notes from the sonographer are loaded for review by a radiologist/clinician. By way of illustration, the imaging procedure loaded at <NUM> may be initially stored on a suitable memory device and transported to another location wherein the sonographer is located. Alternatively, the entire imaging procedure gathered at <NUM> may be transmitted (e.g., by a wired or wireless communication link) and loaded at <NUM> for review by the radiologist/clinician. As will be appreciated, and as will become clearer as the present description continues, by the present teachings, only the IP images are stored and transmitted for loading at <NUM>. Beneficially, compared to known systems that include OOP and IP image data for loading for review by the radiologist/clinician, only the IP images are stored or transmitted for loading at <NUM>. This of course reduces the memory requirements of stored image data, or bandwidth requirements for transmitted image data, or both. As such, and among other benefits, the present teachings reduce the memory requirements, or the bandwidth requirements, or both, for the collection of image data to be reviewed by the radiologist/clinician.

At <NUM>, the image data loaded at <NUM> are reviewed by the radiologist/clinician and measurement are taken by the radiologist/clinician from the IP images. Beneficially, because only the IP images are stored or transmitted for loading at <NUM>, the radiologist/clinician does not have to review less than desirable images (OOP images) at <NUM>. By contrast, image review of known CEUS imaging systems is challenging due to the CEUS loop length (often up to <NUM> minutes of imaging from contrast agent injection). As such, the burden of review in not just time but mental effort by the radiologist/clinician is reduced by the system and methods of the present teachings compared to known systems and methods.

At <NUM> a structured report (SR) or a free text report (FTR) is generated, and at <NUM>, the method <NUM> of reviewing the CEUS image data is complete.

<FIG> is a flow chart of a method <NUM> of removing out-of-plane frames according to a representative embodiment. Modules comprising instructions, which when executed by the processor, cause the processor to carry out the method <NUM>. Various aspects and details of the method are common to those described in connection with representative embodiments of <FIG>. These common aspects and details may not be repeated to avoid obscuring the presently described representative embodiment.

At <NUM>, the method <NUM> begins with the determining OOP frames of a CEUS imaging procedure. As described more fully below, the determining of OOP frames is carried out according to various methods. As alluded to above, and as described more fully below, instructions comprise a module and may be stored in a tangible, non-transitory computer readable medium module that when executed by a processor cause the processor to automatically identify OOP images due to patient or imaging device motion. As noted above, and as described more fully below, the OOP images are undesired artifacts for purposes of diagnosis and treatment. At <NUM> these OOP images are identified for removal during data acquisition by the sonographer.

At <NUM> the method continues with the automatic removal of OOP frames from the CEUS imaging data based on a criterion to provide an optimized set of frames of IP images. Again, instructions stored in memory <NUM> comprise a module for execution by a processor to remove the OOP frames.

As noted above, this removal of OOP images is carried out while the sonographer is performing the CEUS procedure, beneficially reducing the memory requirements for storing the data of the imaging procedure or the bandwidth requirements for transmitting the data of the imaging procedure, or both. As described more fully below, the criteria upon which the decision is made to remove an image from the CEUS procedure for being an OOP procedure may be based on a comparison of normalized cross-correlation coefficients (NCCC) between adjacent frames, or from a comparison of Time Intensity Curve (TIC) data from a TIC curve and the TIC data of the frames gather during the CEUS procedure. Regardless of the type of criterion selected, a comparison to a threshold value, for example, will determine whether a particular frame should be discarded as being an OOP frame, and accordingly whether a particular frame should be saved as an IP frame for further review by the radiologist or other clinician. As such, <NUM> results in reduced memory requirements of the imaging system <NUM>, or the bandwidth requirements for transmission of image data by or in the imaging system <NUM>, or both.

At <NUM>, the method <NUM> is completed by the displaying of optimized sets of frames for review by the radiologist or other clinician. By way of illustration, these optimized sets of frames may be shown on the display <NUM> and further manipulated by the radiologist or other clinician by the GUI <NUM> of the imaging system <NUM>.

<FIG> is a graph of CEUS intensity versus time (also referred to as a TIC curve) for an ideal wash-in and wash-out cycle. Various aspects and details of <FIG> are common to those described in connection with representative embodiments of <FIG>. These common aspects and details may not be repeated to avoid obscuring the presently described representative embodiment.

By the present teachings, the removal of OOP frames eliminates undesired frames and redundancies within the entire cine-loop, and leaves only IP frames for review by the sonographer or other clinician. Beneficially, the remaining IP frames/short cine-loops correspond to significant events such as a phase difference of a liver resulting in onset <NUM> where microbubbles in the contrast agent arrive into the targeted lesion; peak time <NUM> where the targeted lesion shows the strongest enhancement at CEUS image; and the middle time half <NUM> between the onset and peak time, which often occurs <NUM> seconds and <NUM> seconds after the onset.

<FIG> is a graph of CEUS intensity versus time curve (TIC curve) and a fitted TIC curve based on data gathered the CEUS imaging system of <FIG> according to a representative embodiment. Various aspects and details of <FIG> are common to those described in connection with representative embodiments of <FIG>. These common aspects and details may not be repeated to avoid obscuring the presently described representative embodiment.

Turning to <FIG>, raw data of curve <NUM> are the CEUS intensity at various temporal points taken from a CEUS scan of a liver. Illustratively, these data are collected by the sonographer who has identified a targeted suspected lesion either manually or automatically. The suspected lesion can be determined from one of a number of methods such as pre-contrast B-mode image with high mechanical index (MI) (for example: MI=<NUM>); or from a selected frame in a CEUS loop either by its side-by-side B-mode or CEUS image, depending on the contrast ratio between lesion and background.

Notably, the raw data of curve <NUM> are from a relative smaller region of interest (ROI) around the targeted lesion based on the entire motion compensated CEUS loop. Fitted curve <NUM> is fitted curve based on the raw data of curve <NUM>. Fitted curve <NUM> is made using a mathematical model specific to the anatomical part being scanned. Illustratively, the model selected to determine fitted curve <NUM> is a lagged normal model that determines the mean transit time (MTT) of contrast agent across the liver and is given by: <MAT> where µ is the mean of the Lagged normal distribution; and λ is the Péclet number, which is the ratio between the diffusive time and the convective time, estimating the contribution of both the diffusion and the convention of the microbubbles traveling through the vessels, divided by two. Further details of determining MTT values for use in connection with the present teachings may be found in "<NPL>).

As will be appreciated, when applied to other anatomical elements of the body, other mathematical models, which have been found to better track the CEUS contrast intensity versus time for the specific anatomical element being studied, are used. By way of illustration and not limitation, other mathematic models include a lognormal model for the breast and heart; a gamma variate mathematic model for the carotid artery; a local density random walk (LDRW) mathematical model; and a first passage time (FTP) model for the carotid artery. These mathematic models are modules stored in memory <NUM> and comprise instructions, which when executed by a processor take the raw CEUS intensity data from the imaging device and calculate the fitted curve <NUM> for these data.

As will become clearer as the present description continues, using the systems and methods of the present teachings, average values of the data points and standard deviation from the average are determined for each data point. The average value and standard deviation are compared to a threshold to determine the data points classified as in-plane data points, and the frames of these data points will not be removed from the frame data provided to the radiologist/clinician. By contrast, data points of that are greater that exceed the threshold are removed from the data set. By way of illustration, data points <NUM> that are comparatively close to the fitted curve <NUM> are determined by the systems and methods of the present teachings to be in-plane data points. However, data sets <NUM>, <NUM>, <NUM> likely exceed the threshold, and are likely data points from another plane erroneously captured due to relative motion of the body and imaging device <NUM> as discussed above. These data sets are thus determined by the system and methods of the present teachings to be OOP data points and are not stored image data of the CEUS procedure, or are not transmitted to the radiologist/clinician, or both. As noted above and as described more fully below, module to automatically identify OOP frames and loops, and remove them are stored instructions in the memory <NUM>, which are executed by a processor to carry out this identification and removal of OOP frames and loops.

<FIG> is a flow chart of a method <NUM> for determining whether a frame is an in-plane frame or an out-of-plane frame using changes in the TIC curve according to a representative embodiment. Various aspects and details of <FIG> are common to those described in connection with representative embodiments of <FIG>. These common aspects and details may not be repeated to avoid obscuring the presently described representative embodiment. Moreover, and as alluded to above, the method <NUM> is a module comprising instructions stored in memory <NUM>. When executed by a processor, the instructions cause the processor to carry out the method <NUM>.

At <NUM>, a known motion compensation technique is applied to the entire cine-loop and thereby to a relatively larger region that includes the suspected lesion or whole image if necessary.

At <NUM> a TIC curve is generated for the comparatively smaller ROI and around the targeted lesion based on the entire motion compensated CEUS loop. By way of illustration, curve <NUM> is a TIC curved generated for a smaller ROI around a targeted lesion of the liver. After generation of the TIC curve, the method comprises applying a mathematical model suitable for the organ element being scanned by CEUS. Continuing with the example of <FIG>, at this portion of the method, fitted curve <NUM> for the liver is generated using lagged normal model described above.

Next, at <NUM> of the method <NUM>, a difference curve is generated using a difference function (diff(n)) for every temporal data point. In accordance with a representative embodiment, the fitted difference for each CEUS intensity and temporal data point n is computed as<MAT> where OTIC is the original temporal data point, and FTIC is the fitted CEUS temporal data point n.

At <NUM> the method continues with the calculation of standard deviation (std) for the difference curve for every CEUS and temporal data point. In accordance with a representative embodiment, when the OTIC curve value (n) at every temporal point is outside the predetermined range the frame is deemed OOP. Just by way of illustration, the range may be expressed as (FTIC value(n)-<NUM>*std to FTIC value(n) + <NUM>*std) as shown in <FIG>.

At <NUM> the method <NUM> continues with the comparison of each OTIC data point with a threshold value to see if the OTIC data point is in range. In accordance with a representative embodiment, if the value of the OTIC data point is outside a pre-determined range, the frame associated with this data point is considered to be OOP frames. Just by way of illustration, as noted above data sets <NUM>, <NUM>, <NUM> are out-of-range. As alluded to above, the predetermined range relates to OTIC data points that would be in the plane of examination of the ROI (i.e., the initial plane) where the imaging device <NUM> is located at the specific time in the procedure. These data points are kept (stored, or transmitted, or both). By contrast, data points that are out of range would likely be data points gathered during the specific time of the procedure, but in an image plane that differs from the initial plane due to relative motion of the imaging device <NUM> and the body of the patient on whom the CEUS scan is being performed.

By way of illustration, the threshold for determining whether the OITC data point is in range or out of range can be determined using (FTIC value(n)-<NUM>*std to FTIC value(n)+<NUM>*std). Data points in range are kept at <NUM> (stored, or transmitted to the radiologist/clinician, or both) whereas data points that exceed the predetermined range are data points of OOP frames, and are removed/discarded at <NUM>. Notably, both fitted values and OITC values are used to determine the difference function (diff(n)), and the standard deviation is useful to identify an IP or OOP frame.

<FIG> is a flow chart of a method <NUM> of selecting representative CEUS frames or short loops at or near characteristic points of a TIC curve according to a representative embodiment. Various aspects and details of <FIG> are common to those described in connection with representative embodiments of <FIG>. These common aspects and details may not be repeated to avoid obscuring the presently described representative embodiment. Moreover, and as alluded to above, the method <NUM> is a module comprising instructions stored in memory <NUM>. When executed by a processor, the instructions cause the processor to carry out the method <NUM>.

In accordance with a representative embodiment, the TIC curve is determined at <NUM> such as described above.

At <NUM>, the method <NUM> comprises determining characteristic points on the TIC curve to be analyzed. temporal points including, but not limited to, onset of the TIC curve (e.g., <NUM>); middle of wash-in curve or maximal wash-in slope (e.g., <NUM>); peak time of the TIC curve (e.g., <NUM>); middle of wash-out or minimal wash-out slope (e.g., <NUM>); a temporal point around <NUM> seconds based on the America College of Radiology CEUS Liver Imaging, Reporting and Data System (CEUS-LI-RADS); and a temporal point during LP or around <NUM> seconds if considering ACR CEUS-LI-RADs.

At <NUM> representative short loops or frames are selected at or near the characteristic points from <NUM>. By selecting short cine-loops or frames from the entire cine-loop, data from important parts of the CEUS scan can be more easily isolated for review by the radiologist/clinician. Again, because the image data are reduced, less memory or less bandwidth are required for storing the data, or transmitting the data, or both.

At <NUM>, the determination is made whether the selected short loops are IP or OOP loops. Notably, the methods for determining whether a loop comprises IP or OOP data is substantively the same as those used to determine whether a single frame comprises IP or OOP data. As will be appreciated each loop comprises a plurality of frames, so the noted methods to determine IP or OOP loops comprises repeating the method for each frame of the loop. In accordance with one representative embodiment, the determination of whether each frame of a loop is IP or OOP on an individual basis. IP frames of the loop are stored, and OOP frames of the loop are discarded. Accordingly, when the short loops are determined to be IP at <NUM>, the method continues at <NUM>. Otherwise, the method continues at <NUM>.

<FIG> is a flow chart of a method <NUM> for determining whether a frame is an in-plane frame or an out-of-plane frame using changes in NCCC values according to an example which is not part of the claimed invention.

Various aspects and details of <FIG> are common to those described in connection with representative embodiments of <FIG>. These common aspects and details may not be repeated to avoid obscuring the presently described representative example.

Moreover, and as alluded to above, the method <NUM> is a module comprising instructions stored in memory <NUM>. When executed by a processor, the instructions cause the processor to carry out the method <NUM>.

At <NUM>, a known motion compensation method is applied to the entire cine-loop and thereby to a relatively larger region that includes the suspected lesion or whole image if necessary.

At <NUM> the normalized cross-correlation coefficient (NCCC) values are calculated for two adjacent frames for a targeted lesion region based on the entire motion compensated CEUS loop. Notably, adjacent frames are frames consecutive in time and frame number (e.g., frames (n-<NUM>), n, (n+<NUM>)).

In accordance with one representative example, the NCCC values (γ (u, v)) are determined by: calculating the cross-correlation in the spatial or frequency domain, depending on the size (amount of data) of the images; calculating local sums by precomputing running sums; and using the local sums to normalize the cross-correlation to obtain the correlation coefficients. This may be expressed as: <MAT> where.

In the equation above, f and t are functions in two spatial dimensions (x,y) and the actual values of f(x,y) and t(x,y) are used to determine the NCCC value at (x,y).

At <NUM> the method continues with the comparison of the NCCC values calculated in <NUM> to a predetermined threshold value. In accordance with a representative example, the NCCC values are calculated for any two adjacent frames for a region of interest (ROI), such as the region of the targeted lesion region based on the entire motion compensated CEUS loop. Next, out-of-plane frames are determined based on a threshold comparison and removed when they are frames of the selected frames or of the selected short loops when the NCCC value is outside the range of the threshold. Just by way of illustration, in accordance with a representative example, the determination of whether a frame is OOP is based on a pre-defined NCCC value (e.g., <NUM>). When the NCCC value is less than this threshold, the frame is considered OOP and discarded. All other frames are deemed IP and are stored/shared with the clinician reviewing the scan.

If the NCCC value is large enough at <NUM>, the data points are considered in-plane and at <NUM>, the data points of these frames are stored, or transmitted to the radiologist/clinician, or both. If the NCCC value is less than the predetermined threshold, the frame associated with this data point is deemed to be an OOP frame and is discarded at <NUM>.

As will be appreciated by one of ordinary skill in the art having the benefit of the present disclosure, devices, systems and methods of the present teachings provide the transmission of echo image data from an ultrasound device. For example, compared to known methods and systems, various aspects of a protocol including the beginning, duration and termination of a step in the protocol can be facilitated during the generation of the protocol, or during implementation of the protocol, or both. Moreover, errors that can result from human interaction with an imaging system can be reduced thereby reducing the need to repeat procedures, and reducing the time required to complete an imaging procedure. Notably, these benefits are illustrative, and other advancements in the field of medical imaging will become apparent to one of ordinary skill in the art having the benefit of the present disclosure.

Although methods, systems and components for implementing imaging protocols have been described with reference to several exemplary embodiments, it is understood that the words that have been used are words of description and illustration, rather than words of limitation. Changes may be made within the purview of the appended claims, as presently stated and as amended, without departing from the scope of the protocol implementation of the present teachings. The preceding description of the disclosed embodiments is provided to enable any person skilled in the art to practice the concepts described in the present disclosure. As such, the above disclosed subject matter is to be considered illustrative, and not restrictive, and the appended claims are intended to cover all such modifications, enhancements, and other embodiments which fall within the true scope of the present disclosure. Thus, to the maximum extent allowed by law, the scope of the present disclosure is to be determined by the broadest permissible interpretation of the following claims and shall not be restricted or limited by the foregoing detailed description.

Claim 1:
A system for providing ultrasound images, the system comprising:
an ultrasound probe adapted to provide the ultrasound images;
a processor (<NUM>) configured to:
generate (<NUM>, <NUM>) time-intensity-curves for the ultrasound images;
determine (<NUM>), based on the time-intensity-curves, out-of-plane frames of the ultrasound images; and
remove (<NUM>) the out-of-plane frames from the ultrasound images based on a criterion to provide an optimized set of frames; and
a display (<NUM>) in communication with the processor and configured to display (<NUM>) the optimized set of frames.