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The quality of the trans-rectal ultrasound (TRUS) image, and thus seed placement during the prostate brachytherapy (PBT) procedure, relies on the user's technical and clinical competency. Simulation-based medical education can provide a structured approach for the acquisition of clinical competencies, but the efficacy of the training relies on the fidelity of the training simulators. In this work, the design, development and preliminary evaluation of an anthropomorphic training phantom for TRUS PBT is described. TRUS clinical patient data informed the design of 3-D printed moulds to fabricate prostate targets. Tissue-mimicking materials were included that had the sonographic characteristics of the prostate and overlying tissues, as well as the clinically relevant physical response, to provide haptic feedback to the user. Through an iterative design process, prototypes were constructed. These prototypes were quantitatively evaluated using a specification list and evaluated by an experienced clinical brachytherapy oncologist; their feedback was implemented, and the results of this evaluation are presented.

It is important to employ radiation dose reduction techniques in pediatric computed tomography (CT) to reduce potential risks of radiation‐induced malignancy. Automatic tube potential (kV) selection tools have been developed and become available on many CT scanners, which select the optimum kV based on the patient size and clinical task to improve the radiation dose efficiency. However, its use in pediatric CT has been mostly empirical, following manufacturer’s default recommendation without solid demonstration for quality improvement. This study aimed to implement an automatic tube potential tool (CAREkV, Siemens Healthcare) into routine pediatric CT practice, using the “Plan‐Do‐Study‐Act” quality improvement process, in place of an existing kV/mAs technique chart. The design of this quality improvement project involved Plan‐Do‐Study‐Act stages. Plan and Do stages identified the criteria for optimal automatic kV selection; a range of phantoms representing typical pediatric groups were scanned on a dual‐source 128‐slice scanner using a fast‐pitch scanning mode. The identified CAREkV settings were implemented into the CT protocol and evaluated after a 6‐month period. In the Study stage, an objective evaluation of the image metrics and radiation dose for two similar patient cohorts using CAREkV and the technique‐chart, respectively, were compared. The kV selected, image quality and radiation dose determined by CAREkV were comparable to those obtained while using the technique‐chart. The CAREkV was successfully implemented into our pediatric abdominopelvic CT practice. By utilizing the “PDSA” process optimal image quality and radiation dose reduction were achieved with an automatic kV selection tool to improve CT workflow.

Objective To provide an initial report that patients with magnetic resonance imaging (MRI) non-conditional cardiac implanted electronic device (CIED) can undergo state-of-the-art magnetic resonance imaging–guided focused (MRgFUS) ablation procedures with careful planning and integration of the procedure into an established CIED MRI practice. Patient and Methods We describe an MRgFUS ablation treatment of lumbar facet joints in a patient with an MRI non-conditional CIED (pacemaker), completed in accordance with our institutional CIED/MRI practice guidelines. Results A risk-benefit analysis by a coordinated multidisciplinary team before this treatment was performed to account for the risks associated with the MRI non-conditional pacemaker in the context of the MRgFUS procedure. Conclusion The patient had no adverse cardiac event during or following this procedure.

The aim of this work was to establish the optimum acoustic characterisation approach and insonation transmit beam parameters for subharmonic signal generation with ‘native’ and ‘altered’ populations of a commonly-used microbubble contrast agent. Dynamic contrast-enhanced (DCE) ultrasound is a non-invasive method of imaging the microvasculature, typically implemented using harmonic imaging. Subharmonic imaging, in which echoes at half the fundamental frequency are detected, detects signals which are generated by the ultrasound contrast agents (UCAs) but not by tissue. However, optimal transmission parameters and furthermore, the optimum acoustic characterisation method have not been established. The subharmonic response of ‘native’ and ‘altered’ UCA, altered through decantation, was investigated at transmit centre frequencies 1.8–5 MHz and pulse lengths 1–8 cycles. The ‘altered’ UCA had reduced polydispersity (1–4 µm: 82% bubble volume), compared to ‘native’ (4–10 µm: 57% bubble volume). A custom-built narrow-band acoustic characterisation system was found to be more appropriate for acoustic characterisation compared to the commonly used broadband pulse-echo approach. Both UCA generated the highest subharmonic signal at pulse length of 3-cycles. The maximum ‘native’ subharmonic signal was generated at a transmit centre frequency of 1.9 MHz, corresponding to a subharmonic at 0.95 MHz. This optimal frequency increased in the ‘altered’ population to 2.3–2.5 MHz, bringing the subharmonic above 1 MHz and hence into a range amenable to clinical abdominal imaging transducers. The use of subharmonic signal detection coupled with a modified UCA size distribution has potential to significantly improve the quantification sensitivity and accuracy of DCE ultrasound imaging. Keywords: Ultrasound contrast agent; Acoustic characterisation; Subharmonic imaging

Purpose The stiffness of Polyvinyl-alcohol cryogel can be adjusted through application of consecutive freeze-thaw cycles. This material has potential applications in the production of tissue mimicking phantoms in diagnostic ultrasound. The aim of this study was to use PVA-c to produce a range of geometrically and acoustically identical vessel phantoms modelling stages of atherosclerosis which could be verified through mechanical testing, thus allowing for more precision in quantitative in-vitro flow analysis of atherosclerosis. Methods A series of anatomically realistic walled renal artery flow phantoms were constructed using PVA-c. In order to ensure precise modelling of atherosclerosis, a modified procedure of ISO27:2017 was used to compare the mechanical properties of PVA-c. Results were compared for the standard “dumbbell” test object and a modified vessel test object. The geometric accuracy and reproducibility of the vessel models were tested before and after implantation in flow phantoms. Results No significant difference was found between the mechanical properties of the dumbbell test samples and the vessels for any number of freeze thaw cycles, with a correlation coefficient of R2 = 0.9767 across the dataset, indicating that a direct comparison between the mechanical properties of the dumbbell test samples and the phantom vessels was established. The geometric reproducibility showed that before and after implantation there was no significant difference between individual vessel geometries (p = 0.337 & p = 0.176 respectively). Conclusions Polyvinyl-alcohol cryogel is a useful material for the production of arterial flow phantoms. Care should be taken when using this material to ensure its mechanical properties have been correctly characterised. The guidelines of ISO37:2017 potentially provide the best procedure to ensure this.

Brachytherapy is an efficacious treatment option because of its benefits for patient recovery, dose localization and conformity, but these favorable outcomes can be ensured only if the transrectal ultrasound (TRUS) system is optimized for the specific application of ultrasound-guided prostate brachytherapy. The ability to delineate the prostate from surrounding tissue during TRUS-guided prostate brachytherapy is vital for treatment planning, and consequently, so is the contrast resolution. This study describes the development of task-specific contrast-detail phantoms with clinically relevant contrast and spherical target sizes for contrast-detail performance evaluation of TRUS systems used in the brachytherapy procedure. The procedure for objective assessment of the contrast detectability of the TRUS systems is also described; a program was developed in MATLAB (R2017a, The MathWorks, Natick, MA, USA) to quantitatively analyze image quality in terms of the lesion signal-to-noise ratio (LSNR) and validated with representative control test images. The LSNR of the Hitachi EUB-7500A (2013, Hitachi, Ltd, Tokyo, Japan) TRUS system was measured on sagittal and transverse TRUS images of the contrast-detail phantoms described in this work. Results revealed the efficacy of the device as an image quality evaluation tool and the impact of the size, depth and relative contrast of the targets to the surrounding tissue on the contrast detectability of a TRUS system for both transducer arrays. The MATLAB program objectively measured the contrast detectability of the TRUS system and has the potential to determine optimized imaging parameters that could be designed as part of standardization of the imaging protocol used in TRUS-guided prostate brachytherapy for prostate cancer.

Ultrasound imaging training is not required as part of radiation oncology training programs nor does any objective competency measure exist to independently assess performance. Physical simulation training can provide a structured approach to this training but only if suitably challenging training simulators exist. This study describes the design and preliminary evaluation of a simulation-based transrectal ultrasound (TRUS) imaging training workshop developed for medical physicists involved in low-dose-rate (LDR) prostate brachytherapy (PBT).The study incorporated novel high-fidelity anthropomorphic PBT TRUS training simulators and a TRUS imaging module with a blended-learning pedagogical approach, to address TRUS image optimisation and managing image quality.Results demonstrated a significant improvement in knowledge, with an average increase in multiple choice question score of 61% (P 0.0002), and that there was a 46% (P 0.0001) average increase in the participants perceived understanding of TRUS scanner operation, and an increase of 36% (P 0.001) in participants readiness to optimise image quality and mitigate image artefacts. Focus group data explored participants' experiences, perceptions and challenges with TRUS LDR PBT.This study suggests a benefit in offering a simulation training workshop to medical physicists and the potential benefit to other healthcare professionals involved in prostate brachytherapy, by incorporating novel high-fidelity anthropomorphic PBT TRUS training simulators, in a simulated environment to practice ultrasound image optimisation for PBT image guidance. This approach to training would enable competency-based skill acquisition and continued proficiency or health professionals in the TRUS PBT procedure, outside of the surgical environment without direct exposure to patients.

Purpose The aim of this study was to demonstrate that a low helical pitch causes increased photon starvation artifacts at ultra-low-dose CT. Methods A cylindrical water phantom with a diameter of 30 cm was scanned on two different generation CT scanners: a 64-slice scanner (Sensation 64, Siemens Healthcare) and a 192-slice scanner (Somatom Force, Siemens Healthcare) at multiple effective mAs levels (mAs/pitch = 200, 100, 50, 25, and 12). The corresponding CTDIvol values were 4.1, 2.0, 1.0, 0.5 mGy, on the 64-slice scanner and 3.8, 1.9, 1.0, 0.5 mGy on the 192-slice scanner, for the selected effective mAs values. For each dose setting, the scan was repeated at four helical pitches: 1.2, 0.9, 0.6, and the lowest achievable pitch on each scanner. The tube current was automatically adjusted by the scanner so that the effective mAs, and thus CTDIvol , were kept the same for different pitches. All CT data sets were reconstructed with a slice thickness of 3mm and a medium smooth kernel. Images acquired at the same dose level but different helical pitches were visually inspected to assess photon starvation artifacts and noise levels. Results At the same radiation dose, image noise increased with the decreasing helical pitch. The increase was more severe on the old-generation 64-slice scanner. Photon starvation artifacts were evident at 200 effective mAs on the 64-slice scanner at 80 kV. On the 192-slice scanner there was no visible photon starvation artifacts at both 200 and 50 effective mAs (CTDIvol = 4.1 mGy and 1.0 mGy, respectively); nor was there a visible impact from the lower helical pitch. Only when the dose was lowered to be extremely low (~0.26 mGy, achievable at 70 kV), did photon starvation artifacts become evident. Conclusions A low helical pitch may increase image noise and photon starvation artifacts compared to a higher pitch for the same dose level, particularly at ultra-low dose CT.

Purpose Renal arterial stenosis can lead to disrupted renal function due to reduced blood flow to the kidneys and is largely thought to be caused by atherosclerosis. Current diagnostic strategies for renal arterial stenosis rely on detecting large degree stenoses (>50%). This study aimed to test the viability of using Doppler ultrasound to assess velocity profiles to detect the presence of low degree ( Methods A series of anatomically realistic renal artery flow phantoms were constructed exhibiting a range of low degree stenoses (symmetric and asymmetric). The behaviour of fluid flow in the phantoms was examined using Doppler ultrasound and analysed to calculate the clinical biomarker, wall shear stress. Results A number of fluid behaviours were observed in relation to stenosis degree: asymmetric stenoses tended to result in a skewing of peak velocities away from the centre of the vessel towards the outer wall, the magnitude of increase in velocity was observed to correlate with stenosis degree, and the wall shear stress curves observed large peaks in the presence of even the lowest degree stenosis (20%). Conclusions Doppler ultrasound could potentially be utilised to diagnose low degree stenoses in a clinical setting. Doppler ultrasound in conjunction with wall shear stress analysis in particular has significant potential in the diagnosis of renal artery stenosis.

PURPOSE This study evaluated the training and assessment role of anthropomorphic breast ultrasound phantoms that simulated both the morphological and sonographic characteristics of breast tissue, including lesions, in a group of radiology residents at a large academic medical center. METHODS This was a prospective study involving nine residents across second to fourth years of a radiology residency program. Two devices (phantom 1 and phantom 2) were designed and constructed to produce similar realistic sonographic images of breast morphology with a range of embedded pathologies to provide a realistic training experience. Baseline assessments of all residents' ability to detect and characterize lesions in phantom 1 were carried out, followed by a 2-hour teaching session on the same phantom. All residents underwent a posttraining, final assessment on phantom 2 to evaluate changes in their lesion detection rate and ability to correctly characterize the lesions. RESULTS The results demonstrated there was a significant increase in both the pooled detection and correct characterization score for all residents pre- and posttraining of 26% ± 14% and 17% ± 8%, P < .0003, respectively. Posttraining assessment surveys revealed that residents rated the training experience highly. CONCLUSIONS This study suggests that there is a benefit in including a simulation training workshop with a novel anthropomorphic breast ultrasound training device to a radiology resident education program. Finally, the phantoms used in this study are useful for training and assessment purposes because they provide a lifelike simulation of breast tissue to practice ultrasound imaging without direct exposure to patients, in an environment with no pressure.

In this paper we consider radar approaches for breast cancer detection. The aim is to give a brief review of the main features of incoherent methods, based on beam-forming and Multiple SIgnal Classification (MUSIC) algorithms, that we have recently developed, and to compare them with classical coherent beam-forming. Those methods have the remarkable advantage of not requiring antenna characterization/compensation, which can be problematic in view of the close (to the breast) proximity set-up usually employed in breast imaging. Moreover, we proceed to an experimental validation of one of the incoherent methods, i.e., the I-MUSIC, using the multimodal breast phantom we have previously developed. While in a previous paper we focused on the phantom manufacture and characterization, here we are mainly concerned with providing the detail of the reconstruction algorithm, in particular for a new multi-step clutter rejection method that was employed and only barely described. In this regard, this contribution can be considered as a completion of our previous study. The experiments against the phantom show promising results and highlight the crucial role played by the clutter rejection procedure.

PURPOSE To investigate cryoneedle heating risks during magnetic resonance (MR)-guided cryoablation and potential strategies to mitigate these risks. MATERIALS AND METHODS Ex vivo experiments were performed on a 1.5-Tesla (T) MR scanner using an MR conditional cryoablation system on porcine tissue phantoms. Cryoneedles were placed inside the tissue phantom either with or without an angiocatheter. Typical cryoneedle geometric configurations (including gas supply line) encountered in clinical procedures with low to high expected heating risks were investigated. Up to 4 fiber optic temperature sensors were attached to the cryoneedle/angiocatheter to measure the MR-induced cryoneedle heating at different locations during MR with different estimated specific absorption rates (SARs). The impact of cryoneedle heating on cryoablation treatment was studied by comparing temperature changes during 10-min freeze-thaw cycles with and without MR. RESULTS Rapid temperature increases of >100 °C in < 2 minutes were observed during MR with a SAR of 2.1 W/kg. The temperature changes during a typical freeze-thaw cycle were also affected by cryoneedle heating when MR was used to monitor the ice-ball evolution. The observed cryoneedle heating was affected by multiple factors; including cryoneedle geometric configurations, sequence SAR, whether an angiocatheter was used, and whether the cryoneedle was connected to the rest of the cryoablation system. CONCLUSIONS The ex vivo experiments demonstrated that MR could induce significant cryoneedle heating risks. Furthermore, MR-induced cryoneedle heating can affect temperatures in the ice-ball evolution during the freeze-thaw cycle. Several practical strategies to reduce the cryoneedle heating have been proposed.

Objectives The aim of this study was to evaluate the impact of technology improvements on the outcomes of magnetic resonance-guided focused ultrasound (MRgFUS) treatments of symptomatic uterine leiomyomas (uterine fibroids). The study compared ablation volumes and incidence of adverse events in patient groups treated with two generations of MRgFUS systems from a single vendor. Methods The present study describes the results of a retrospective comparative study of two groups of women with symptomatic uterine leiomyomas who were clinically treated with MRgFUS at a single institution. Group 1 (n = 130) was treated using the first-generation system between March 2005 and December 2009. Group 2 (n = 71) was treated using the second-generation between December 2013 and September 2019. Results The second-generation MRgFUS system resulted in significantly improved nonperfused volume ratios in both dark and bright T2 fibroid categories compared with the first-generation system (dark – 80% versus46 %, p = 0.00002 and bright – 46% versus 32%, p = 0.001). There have been no recorded hospital admissions, no skins burns, and no reported major adverse events since the introduction of this second-generation ExAblate 2100 system with advanced safety and treatment planning features. Conclusion This study has demonstrated that improvements to current MRgFUS technology resulted in significantly increased efficacy and patient safety of clinical treatments of patients with symptomatic uterine leiomyomas.

The aim of this work was to develop multimodal anthropomorphic breast phantoms suitable for evaluating the imaging performance of a recently-introduced Microwave Imaging (MWI) technique in comparison to the established diagnostic imaging modalities of Magnetic Resonance Imaging (MRI), Ultrasound (US), mammography and Computed Tomography (CT). MWI is an emerging technique with significant potential to supplement established imaging techniques to improve diagnostic confidence for breast cancer detection. To date, numerical simulations have been used to assess the different MWI scanning and image reconstruction algorithms in current use, while only a few clinical trials have been conducted. To bridge the gap between the numerical simulation environment and a more realistic diagnostic scenario, anthropomorphic phantoms which mimic breast tissues in terms of their heterogeneity, anatomy, morphology, and mechanical and dielectric characteristics, may be used. Key in this regard is achieving realism in the imaging appearance of the different healthy and pathologic tissue types for each of the modalities, taking into consideration the differing imaging and contrast mechanisms for each modality. Suitable phantoms can thus be used by radiologists to correlate image findings between the emerging MWI technique and the more familiar images generated by the conventional modalities. Two phantoms were developed in this study, representing difficult-to-image and easy-to-image patients: the former contained a complex boundary between the mammary fat and fibroglandular tissues, extracted from real patient MRI datasets, while the latter contained a simpler and less morphologically accurate interface. Both phantoms were otherwise identical, with tissue-mimicking materials (TMMs) developed to mimic skin, subcutaneous fat, fibroglandular tissue, tumor and pectoral muscle. The phantoms&rsquo, construction used non-toxic materials, and they were inexpensive and relatively easy to manufacture. Both phantoms were scanned using conventional modalities (MRI, US, mammography and CT) and a recently introduced MWI radar detection procedure called in-coherent Multiple Signal Classification (I-MUSIC). Clinically realistic artifact-free images of the anthropomorphic breast phantoms were obtained using the conventional imaging techniques as well as the emerging technique of MWI.

The aim of this study was to investigate the effect of the temporal resolution (T res) and acquisition duration (AD) on the measurement accuracy of contrast concentration–time curves (CTCs), and derived phenomenological and pharmacokinetic parameter values, in a dynamic contrast-enhanced MRI experiment using a novel phantom test device. ‘Ground truth’ CTCs were established using a highly precise optical imaging system. These precisely known CTCs were produced in an anthropomorphic environment, which mimicked the male pelvic region, and presented to the MRI scanner for measurement. The T res was varied in the range [2–24.4 s] and the AD in the range [30–600 s], and the effects on the measurement accuracy were quantified. For wash-in parameter measurements, large underestimation errors (up to 40%) were found using T res values ≥16.3 s; however, the measured wash-out rate did not vary greatly across all T res values tested. Errors in derived K trans and v e values were below 14 and 12% for acquisitions with {T res ≤ 8.1 s, AD ≥ 360 s} and {T res ≤ 16.3 s, AD ≥ 360 s}, respectively, but increased dramatically outside these ranges. Errors in measured wash-in, wash-out, K trans, and v e parameters were minimised using T res ≤ 8.1 s and AD ≥ 360 s, with large errors recorded outside of this range.

Practical non-invasive equipment modifications and effective acquisition methods to achieve robust and reliable real-time MR thermometry for monitoring of clinical hepatic microwave ablations were implemented. These included selection of the microwave generator location (inside versus outside the MR scan room), the number of radiofrequency chokes added to the microwave generator’s coaxial lines, and the use of copper wool to maximize their electrical grounding. Signal-to-noise ratio (SNR) of MR thermometry images of a small fluid-filled phantom acquired during activation of microwave antenna were used to evaluate image quality as a function of each modification. SNR measurements corresponding to both locations of the microwave generator were comparable and so it was located outside the MR scan room. For this location, addition of one RF choke on the power and four chokes on the sensor coaxial lines was found to be optimal, corresponding to a 68% increase in SNR. Furthermore, image quality strongly depended on the proper electrical grounding of the power and sensor lines. SNR ratio (relative to SNR of baseline images) during activation of microwave generator was found to be 0.49 ± 0.28 without adequate grounding, and 0.88 ± 0.08 with adequate grounding (p = 0.002, Student’s t-test). These SNR measurements were sufficiently sensitive to detect issues related to equipment performance and hence formed part of the quality assurance testing performed prior to each clinical treatment. Incorporating these non-invasive approaches resulted in significant improvements to image quality and, importantly while maintaining the clinical integrity of the microwave system which is of paramount importance in a highly regulated healthcare environment.

Purpose It is unclear if a 3D transducer with the special design of mechanical swing or 2D array could provide acceptable 2D grayscale image quality for the general diagnosis purpose. The aim of this study is to compare the 2D image quality of a 3D intracavitary transducer with a conventional 2D intracavitary transducer using clinically relevant phantom experiments. Methods All measurements were performed on a GE Logiq E9 scanner with both a 2D (IC5‐9‐D) and a 3D (RIC5‐9‐D) transducer used in 2D mode. Selection of phantom targets and acquisition parameters were determined from analysis of 33 clinical pelvic exams. Depth of penetration (DOP), contrast response, contrast of anechoic cylinders (diameter: 6.7 mm) at 1.5 and 4.5 cm depths in transverse planes, and in‐plane resolution represented by full‐width half‐maximum of pin targets at multiple depths were measured with transmit frequencies of 7 and 8 MHz. Spherical signal‐noise‐ratio (SNR) (diameter: 4 and 2 mm) at multiple depths were measured at 8 MHz. Results RIC5‐9‐D demonstrated 0.05; 8 MHz: 17.7 ± 0.9 dB, P

A novel anthropomorphic flow phantom device has been developed, which can be used for quantitatively assessing the ability of magnetic resonance imaging (MRI) scanners to accurately measure signal/concentration time-intensity curves (CTCs) associated with dynamic contrast-enhanced (DCE) MRI. Modelling of the complex pharmacokinetics of contrast agents as they perfuse through the tumour capillary network has shown great promise for cancer diagnosis and therapy monitoring. However, clinical adoption has been hindered by methodological problems, resulting in a lack of consensus regarding the most appropriate acquisition and modelling methodology to use and a consequent wide discrepancy in published data. A heretofore overlooked source of such discrepancy may arise from measurement errors of tumour CTCs deriving from the imaging pulse sequence itself, while the effects on the fidelity of CTC measurement of using rapidly-accelerated sequences such as parallel imaging and compressed sensing remain unknown. The present work aimed to investigate these features by developing a test device in which 'ground truth' CTCs were generated and presented to the MRI scanner for measurement, thereby allowing for an assessment of the DCE-MRI protocol to accurately measure this curve shape. The device comprised a four-pump flow system wherein CTCs derived from prior patient prostate data were produced in measurement chambers placed within the imaged volume. The ground truth was determined as the mean of repeat measurements using an MRI-independent, custom-built optical imaging system. In DCE-MRI experiments, significant discrepancies between the ground truth and measured CTCs were found for both tumorous and healthy tissue-mimicking curve shapes. Pharmacokinetic modelling revealed errors in measured K trans, v e and k ep values of up to 42%, 31%, and 50% respectively, following a simple variation of the parallel imaging factor and number of signal averages in the acquisition protocol. The device allows for the quantitative assessment and standardisation of DCE-MRI protocols (both existing and emerging).

The objective of the study was to investigate whether clinically used ultrasonic contrast agents improved the accuracy of spectral Doppler ultrasound in the detection of low grade (50%) renal artery stenosis. Low grade stenoses in the renal artery are notoriously difficult to reliably detect using Doppler ultrasound due to difficulties such as overlying fat and bowel gas.A range of anatomically-realistic renal artery phantoms with varying low degrees of stenosis (0, 30 and 50%) were constructed and peak velocity data was measured from within the pre-stenotic and mid-stenotic regions in each phantom, for both unenhanced and contrast-enhanced spectral Doppler data acquisitions. The effect of a 20 mm overlying fat layer on the ultrasound beam distortion and phase aberration, and hence on the measured peak velocity data, was also investigated.The overlying fat layer produced a statistically significant underestimation (p 0.01) in both the peak velocity and peak velocity ratio [Stenotic Region(Vmax)/Pre-stenotic Region(Vmax)] for the 0% and 30% stenosis models, but not the 50% model. A statistically significant increase (p 0.01) in the peak velocity was found in the contrast-enhanced Doppler spectra; however, no significant difference was found between the unenhanced and contrast enhanced peak velocity ratio data, which suggests that the ratio metric has better diagnostic accuracy. The peak velocity ratios determined for each of the contrast-enhanced phantoms correctly predicted if the phantom had a stenosis and furthermore correctly classified the degree of stenosis.Contrast-enhanced Doppler ultrasound could significantly assist in the early detection of renal artery disease.

Purpose An investigation was carried out into the effect of three image registration techniques on the diagnostic image quality of contrast-enhanced magnetic resonance angiography (CE-MRA) images. Methods Whole-body CE-MRA data from the lower legs of 27 patients recruited onto a study of asymptomatic atherosclerosis were processed using three deformable image registration algorithms. The resultant diagnostic image quality was evaluated qualitatively in a clinical evaluation by four expert observers, and quantitatively by measuring contrast-to-noise ratios and volumes of blood vessels, and assessing the techniques' ability to correct for varying degrees of motion. Results The first registration algorithm (‘AIR’) introduced significant stenosis-mimicking artefacts into the blood vessels' appearance, observed both qualitatively (clinical evaluation) and quantitatively (vessel volume measurements). The two other algorithms (‘Slicer’ and ‘SEMI’), based on the normalised mutual information (NMI) concept and designed specifically to deal with variations in signal intensity as found in contrast-enhanced image data, did not suffer from this serious issue but were rather found to significantly improve the diagnostic image quality both qualitatively and quantitatively, and demonstrated a significantly improved ability to deal with the common problem of patient motion. Conclusions This work highlights both the significant benefits to be gained through the use of suitable registration algorithms and the deleterious effects of an inappropriate choice of algorithm for contrast-enhanced MRI data. The maximum benefit was found in the lower legs, where the small arterial vessel diameters and propensity for leg movement during image acquisitions posed considerable problems in making accurate diagnoses from the un-registered images.

The development and acoustical characterisation of a range of novel agar-based tissue mimicking material (TMMs) for use in clinically relevant, quality assurance (QA) and anthropomorphic breast phantoms are presented. The novel agar-based TMMs described in this study are based on a comprehensive, systematic variation of the ingredients in the International Electrotechnical Commission (IEC) TMM. A novel, solid fat-mimicking material was also developed and acoustically characterised. Acoustical characterisation was carried out using an in-house scanning acoustic macroscope at low (7.5 MHz) and high frequencies (20 MHz), using the pulse-echo insertion technique. The speeds of sound range from 1490 to 1570 m. s(-1), attenuation coefficients range from 0.1 to 0.9 dB. cm(‑1). MHz(-1) and relative backscatter ranges from 0 to -20 dB. It was determined that tissues can be mimicked in terms of independently controllable speeds of sound and attenuation coefficients. These properties make these novel TMMs suitable for use in clinically relevant QA and anthropomorphic phantoms and would potentially be useful for other high frequency applications such as intravascular and small animal imaging.

A device for the training and quantitative assessment of the competency of trainee radiologists in the technically challenging area of breast sonography was developed and evaluated. Currently, suitable commercially available devices are lacking, and there is a growing realization that the reliance on direct exposure to patients for learning may not represent best practice from either the trainees' or patients' perspective. Three devices (PI, PII and PIII) were designed to produce very realistic sonographic images of breast morphology with a range of embedded pathologies. The pilot evaluation used a case study research design to evaluate the role of the anthropomorphic breast sonography training device in training and assessment in a clinical environment. Through the case study, it was possible to evaluate the process and relationships when using this type of training intervention for a small group of radiology resident trainees. The investigation involved a baseline assessment of trainees' (n = 4) ability to detect and characterize all lesions in PI, followed by a 4-wk training period on PII and a post-training assessment using PIII. The evaluation revealed an improvement of 30% ± 8% in the trainee's performance from pre- to post-training. It was expected that the performance of the trainees would improve as the training phantom described in this study aligns with the learning theory of constructivism and fits the ideal specifications of a medical training device in terms of its realism and facilitation of self-directed learning and deliberate practice of the trainees. The device provides a useful platform upon which training and assessment can be facilitated.

Commercially available ultrasound quality assurance test phantoms rely on the long-term acoustic stability of the tissue-mimicking-material (TMM). Measurement of the acoustic properties of the TMM can be technically challenging, and it is important to ensure its stability. The standard technique is to film-wrap samples of TMM and to measure the acoustic properties in a water bath. In this study, a modified technique was proposed whereby the samples of TMM are measured in a preserving fluid that is intended to maintain their characteristics. The acoustic properties were evaluated using a broadband pulse-echo substitution technique over the frequency range 4.5–50 MHz at 0, 6 and 12 months using both techniques. For both techniques, the measured mean values for the speed of sound and attenuation were very similar and within the International Electrotechnical Commission-recommended value. However, the results obtained using the proposed modified technique exhibited greater stability over the 1-y period compared with the results acquired using the standard technique.

Ultrasound guided brachytherapy for the treatment of prostate cancer has become a routine treatment option, due to many benefits including patient recovery and dose localisation [1]; however it is not clear whether the standards which govern the image quality for these systems are adequate. Upon review of the recommended standards for ultrasound systems used in prostate brachytherapy procedures, the recommended tests do not appear to be specific to the clinical application of ultrasound guided prostate brachytherapy. Rather they are generic and similar to those recommended for other clinical applications such as general abdominal scanning [2]. Furthermore, there is growing evidence that these tests should be specific to the clinical application [3,4] in order to gain meaningful data about the performance of the system for the application, and also to detect clinically relevant changes in quality control results. An additional problem is that there are no clinically relevant test phantom recommended for the quality assurance of ultrasound systems used in prostate brachytherapy. The image quality for this application of ultrasound needs to be monitored to ensure consistent levels of confidence in the procedure. This paper reviews the currently recommended test guidelines and test phantoms for ultrasound systems used in prostate brachytherapy from the different standard bodies and professional organisations. A critical analysis of those tests which are most reflective of the imaging and guidance tasks undertaken in an ultrasound guided prostate brachytherapy procedure will also be presented to inform the design of a TRUS quality assurance protocol.

In this paper, an overview of Doppler ultrasound quality assurance (QA) testing will be presented in three sections. The first section will review the different Doppler ultrasound parameters recommended by professional bodies for use in QA protocols. The second section will include an evaluation and critique of the main test devices used to assess Doppler performance, while the final section of this paper will discuss which of the wide range of test devices have been found to be most suitable for inclusion in Doppler QA programmes. Pulsed Wave Spectral Doppler, Colour Doppler Imaging QA test protocols have been recommended over the years by various professional bodies, including the UK's Institute of Physics and Engineering in Medicine (IPEM), the American Institute for Ultrasound in Medicine (AIUM), and the International Electrotechnical Commission (IEC). However, despite the existence of such recommended test protocols, very few commercial or research test devices exist which can measure the full range of both PW Doppler ultrasound and colour Doppler imaging performance parameters, particularly quality control measurements such as: (i) Doppler sensitivity (ii) colour Doppler spatial resolution (iii) colour Doppler temporal resolution (iv) colour Doppler velocity resolution (v) clutter filter performance and (vi) tissue movement artefact suppression. In this review, the merits of the various commercial and research test devices will be considered and a summary of results obtained from published studies which have made use of some of these Doppler test devices, such as the flow, string, rotating and belt phantom, will be presented.

Dynamic Contrast-Enhanced Ultrasound using ultrasound contrast agents (UCA) is a non-invasive method of imaging the microvasculature, typically employing harmonic signal detection. Detection of subharmonic signals, which are generated by the UCAs but not by tissue, holds potential for improving quantification accuracy. However, optimal transmission parameters have not yet been established. The aim of this work was to investigate the effect of transmit beam parameters on subharmonic signal generation for native and size-altered populations of SonoVue®. Native and size-altered SonoVue® populations, altered through decantation, were insonated with various transmit beams, across the frequency range 1.8–5 MHz and pulse lengths 1–8 cycles using a narrowband through-transmission system. Spectral analysis was performed using the Welch Periodogram and corrected for transmit and receive sensitivities of the single-element transducers (Olympus, USA). The size-altered UCA had reduced polydispersity (82% volume: 1–4 μm), compared to native (57% volume: 4–10 μm). Both responded with highest subharmonic signal when insonated at 3 cycles pulse length. The subharmonic signal from the native population was maximised over the transmit range 1.9–2.5 MHz, narrowing to 2.3–2.5 MHz for the size-altered UCA. This latter range produces subharmonic signals at clinically detectable frequencies for abdominal imaging. Data showed that there is lower subharmonic generation thresholds when insonated near the resonance frequency. Optimal transmit beam parameters have been established for maximising the subharmonic signal from SonoVue®. Furthermore, altering the size distribution shifted the frequency of maximum subharmonic to a clinically-useful detection range. Additionally, a clinical scanner investigation using this optimised methodology will be presented.

Antennas designed to link footwear sensors within body centric networks are introduced with two small UWB antennas, one directional and another quasi-omnidirectional. The radiating characteristics are evaluated for three positions on a sample sports shoe using a detailed simulation model and measurements with a homogenous foot phantom. Antenna performance is assessed for resilience to close proximity loading by the footwear materials and the phantom foot.

Polyvinyl alcohol cryogel (PVA-C) is presented as a vessel-mimicking material for use in anatomically realistic Doppler flow phantoms. Three different batches of 10% wt PVA-C containing (i) PVA-C alone, (ii) PVA-C with antibacterial agent and (iii) PVA-C with silicon carbide particles were produced, each with 1-6 freeze-thaw cycles. The resulting PVA-C samples were characterized acoustically (over a range 2.65 to 10.5 MHz) and mechanically to determine the optimum mixture and preparation for mimicking the properties of healthy and diseased arteries found in vivo. This optimum mix was reached with the PVA-C with antibacterial agent sample, prepared after two freeze/thaw cycles, which achieved a speed of sound of 1538 ± 5 m s(-1) and a Young's elastic modulus of 79 ± 11 kPa. This material was used to make a range of anatomically realistic flow phantoms with varying degrees of stenoses, and subsequent flow experiments revealed that higher degrees of stenoses and higher velocities could be achieved without phantom rupturing compared with a phantom containing conventional wall-less vessels.

During prostate brachytherapy the dose delivered to the prostate gland, and the optimal locations of the radioactive seeds is informed by the volume of the gland. The volume is determined using planimetery software that utilises images of the prostate with the border defined by the oncologist, acquired at 5 mm intervals along the length of the prostate. Delineation of the prostate from the surrounding tissue in trans-rectal ultrasound (TRUS) guided prostate brachytherapy is vital to plan and perform the procedure, and the relative soft tissue contrast will have an impact on successful delineation. In order to evaluate the ultrasound system’s contrast-detectability, a novel phantom was designed and developed that included 2, 4, 6, 8 and 10 mm diameter spherical targets of a range of clinically relevant contrasts, embedded in background material. IEC agar tissue mimicking material (TMM) was used and was optimised to achieve the clinically relevant contrasts specific to the prostate brachytherapy procedure, −4 dB −5 dB and −6 dB from a background TMM. Images of these contrast detail targets at each size were acquired across the available ultrasound system settings, including the clinical preset used during the procedure on both the linear and tightly curved transducer arrays. A Matlab program was developed to objectively measure the contrast-detectability of the images in terms of the lesion-signal-to-noise ratio over a range of depths within the phantom for each contrast level. The phantom was used to perform evaluation of the contrast-detectability of TRUS systems, and determine optimal system settings to enhance contrast and facilitate prostate delineation.

This paper gives an overview of the considerations and practical aspects of writing up the results of your research, which may be of interest to those beginning their research career or simply carrying out a research project for the first time as part of an academic qualification. It outlines practical steps for both writing up the results of your research as an academic report and thereafter disseminating your results more widely as a peer-reviewed scientific publication.

Research is the lifeblood of medicine, with innovations being made in the different technologies used to diagnose and/or screen for the presence of disease or to deliver treatments with higher efficacy. Scientific publication is the network of vessels which delivers the lifeblood. The outputs of research provide us with tomorrow's medicine. In this series of articles we will be discussing the different aspects of carrying out research, from the conception of the research idea to publication in a peer reviewed journal, with the cycle repeating again with new research ideas emerging from the research conducted.

The ability to detect flow is the most crucial aspect of an ultrasound (US) system because, if flow cannot be detected, no other aspect of performance matters. The objectives of this study were to validate a Doppler "sensitivity performance index," a figure of merit, and to determine if it could be used to differentiate colour Doppler sensitivity performance in scanners of varying complexity. The sensitivity performance index was developed to give a combined measure of related aspects of sensitivity, such as the lowest detectable velocity, the vessel size and the penetration depth. The colour Doppler sensitivity was evaluated objectively as the lowest detectable velocity signal from the deepest achievable point within the Doppler sensitivity phantom free from extraneous noise in a small diameter vessel (3.2 mm inner diameter). The effect of vessel size and mean velocity on the sensitivity performance index were investigated and it was found that the index was not proportional to vessel size, but this may be accounted for by considering the effect of the acoustic properties of the vessel material, the clutter filter and beam shape. The results obtained using flow phantoms with vessel sizes different from those used in this study are, therefore, not directly comparable to the results found in this study; however, a similar trend should be found in the results for the effect of control settings and a similar range of US scanners. It was found that the Doppler sensitivity performance index was a robust challenging test because none of the US scanners evaluated was capable of achieving the highest sensitivity performance index score, which would be limited by the lowest pump velocity and the deepest point of the vessel within the flow phantom. Therefore, this suggests that this method of determining Doppler sensitivity performance is valuable in the absence of other suitable methods, despite the fact that the relationship between the sensitivity performance index and vessel size is not proportional. Furthermore, use of the Doppler sensitivity performance index for the evaluation of a range of scanners demonstrated that curvilinear transducers have higher sensitivity performance indices than higher-frequency linear transducers, due to the higher achievable penetration depth. The effect of instrument settings was assessed for two transducers, the 4C3 curvilinear general-purpose transducer (Aspen) and the PVM375AT curvilinear general-purpose transducer (Nemio). The colour Doppler sensitivity performance was found to be significantly dependent on the clutter filter setting and the output power setting for both transducers tested. Users need to be aware of the effect of these settings on the colour Doppler sensitivity performance of their US scanner when interpreting the clinical significance of the colour Doppler information.

The aim of this paper is to investigate the relationship between B-mode and colour Doppler technical test methods with the clinical perception of B-mode and Doppler in vivo test parameters. It was found that technical and clinical comparisons between the B-mode test parameters — lateral resolution versus clinical resolution, anechoic target detection versus clinical noise and penetration depth versus clinically useful penetration depth — demonstrated moderate correlations ( r = –0.69, p < 0.003; r = 0.5, p = 0.14; and r = 0.56, p < 0.03, respectively). However, axial resolution versus tissue texture variation, slice thickness versus overall clinical image quality and contrast resolution versus clinically useful dynamic range demonstrated poor correlations. The majority of the colour Doppler performance parameters were found to demonstrate moderate correlations: sensitivity performance index and clinical Doppler sensitivity ( r = 0.52, p < 0.07); axial/lateral resolution and clinical colour Doppler resolution ( r = –0.64, p = 0.02/–0.55, p = 0.05); and temporal resolution and clinical temporal resolution ( r = –0.59, although not statistically significant p = 0.4). The poor correlations for axial resolution slice thickness and contrast resolution suggest that some revision of the test protocols may be required or that these quantities are not as important as previously thought in image quality. Whereas, the test protocols for anechoic target detection, penetration depth and, in particular, lateral resolution appear promising in their prediction of clinical perception of image quality. The newly developed colour Doppler test protocols and test objects also appear promising in their prediction of clinical perception and merit further investigation.

Prostate cancer is the most diagnosed invasive cancer in men in Ireland at 35.1% [1] . In Europe in 2004 prostate cancer accounted for 15.5% of newly diagnosed cancer cases, making it the second most frequent cancer in European men [2] . Ultrasound guided brachytherapy for prostate cancer has become a routine treatment option, largely due to its benefits for patient recovery, dose localisation and conformity [3] ; however it is not clear whether the standards which govern the image quality for these systems is adequate. Upon review of the recommended standards for ultrasound system used in prostate brachytherapy procedures, the recommended tests do not appear to be clinical application specific rather they are similar to those recommended for general abdominal imaging and breast imaging [3] , whereas there is growing evidence that these tests should be specific to the clinical application [4] , [5] . Furthermore, there is no specific recommended test device for testing ultrasound systems used for guidance in prostate brachytherapy. This poster will review the current test guidelines and critically evaluate which are most reflective of the imaging and guidance tasks undertaken in an ultrasound guided prostate brachytherapy procedure. Furthermore, a review of the currently available commercial and research test devices will be undertaken and presented. The concluding aspect of this review will be a proposal of the potentially most clinical reflective test parameters for ultrasound systems for guidance in prostate brachytherapy procedures and finally the specification for a test device which can evaluate these test parameters will be presented.

The development of arterial disease in the renal arteries is of clinical interest as it is associated with increased risk of conditions such as heart failure, hypertension, diabetes mellitus and cerebrovascular disease (Ganz and Hsue, 2013) [1] . A biomechanical marker of this damage is Wall Shear Stress (WSS), which plays a significant role in maintaining proper arterial functioning, and is linked to arterial wall stiffening and the formation of atherosclerotic plaques, and also contributes to the initiation and possibly the progression of atherosclerotic disease (Ganz and Hsue, 2013) [1] , (Zalunardo and Tuttle, 2004) [2] and (Chien et al., 1998) [3] . The effect of WSS on haemodynamic flow, is hence of considerable scientific and clinical interest. This poster will firstly, present an overview of wall shear stress and then critically review the different attempts which have been made to measure WSS, namely, magnetic resonance imaging and conventional pulsed-wave Doppler ultrasound techniques. The main limitations associated with both of these techniques are their inability to detect low blood velocity and also their poor velocity resolution, both of which are critical for accurate WSS measurements (Katritsis et al., 2007) [4] and (Torii et al., 2009) [5] . One approach which can be potentially implemented to improve the SNR and velocity resolution of pulsed-wave Doppler ultrasound is ultrasound microbubble contrast agents. However, ultrasound contrast agents have been used with limited success to improve the quality of the velocity information from blood and the main results from these studies will be discussed in this poster. Finally, the concluding aspect of this review will be a discussion of whether the determination of wall shear stress can be achieved using commercially available ultrasound systems.

The objectives of this study were to evaluate a novel design dynamic force platform the Quantitative Posturography System (QPS). The evaluation consisted of identifying the effects due to ageing and disease of the postural control system and also to examine the relationship between functional performance and postural sway. An AOVA design and Pearson-Product correlation design were used. Seventy healthy subjects, seven subjects with Parkinson’s disease and eight subjects with a history of falls took part in the study. It was found that the QPS was able to identify changes due to both the ageing process and disease on the postural control system. Also a moderate correlation coefficient was found between the sway parameters of the QPS and the two functional balance assessment tests, the Single Leg Stance Test (SLST) and the Functional Reach Test (FR test). In conclusion, the QPS was able to detect the change in the postural control system due to both the ageing process and disease. It was also found that there is a moderately strong relationship between functional performance and postural sway.

The sampling frequencies (fs) at which dynamic contrast enhanced (DCE) MRI data are acquired is known to affects the accuracy of derived parameters. Phenomenological parameters empirically characterise the shape and structure of the signal-time curves, whereas pharmacokinetic approaches estimate physiologically relevant parameters from the concentration-time curves, such as the volume-transfer constant (Ktrans) and the extravascular-extracellular fractional volume (ve). Both of these approaches have shown promise in the detection of prostate cancer, however to date a method has been lacking to quantitatively compare MR-measured to known ‘ground truth’ parameter values. In the present work, a newly developed anthropomorphic DCE-MRI prostate phantom was utilised to this end. Precisely known ‘healthy’ and ‘tumorous’ curves were measured using a 3T scanner (Philips, Netherlands) and 32-channel detector coil (3D-SPGR, TR/TE = 4.3/1.4 ms, α = 10°, FOV = 224 × 224 × 80 mm3, voxels = 1 × 1 × 4 mm3) at fs = 0.5, 0.26, 0.19, 0.12, 0.061, and 0.041 Hz. Phenomenological analysis revealed that wash-in was measured with the lowest errors ( 15%) at fs ⩾ 0.12 Hz, whereas wash-out gave comparatively higher errors (up to 27%) across this same range of fs. Lowest errors in time-to-peak ( 11%) were measured using fs = 2 s and 8.1 s. Pharmacokinetic analysis using the Tofts model gave errors in Ktrans and ve values 14% and 10%, for acquisitions with fs ⩾ 0.12 Hz and fs ⩾ 0.061 respectively, with errors increasing dramatically (up to 172%) with fs 0.061 Hz. Quantitative phantom-based approaches, such as the one used herein, offers the prospect of a standardisation in the way DCE-MRI is performed in the prostate, and possibly a wider acceptance of the technique for routine clinical use. Acknowledgement This work is funded by Irish Cancer Society Research Scholarship CRS13KNI (supported by Movember).

Polyvinyl alcohol cyrogel (PVA-C) is commonly utilised in ultrasound flow phantoms due to its variable Young’s modulus, which can be manipulated through successive freeze-thaw cycles. Vessel mimicking material (VMM) was prepared using PVA-C with varying concentrations of Aluminium Oxide (Al2O3) to optimise the production. These samples were characterised acoustically and mechanically to determine the optimum concentrations of constituent chemicals to adequately mimic the properties of healthy and diseased vessels found in vivo. The optimised mixture was determined using a PVA-C sample prepared after two freeze-thaw cycles, with a speed of sound of 1530 ± 5 m/s and an attenuation of 0.521 ± 0.02 dB cm−1 MHz−1. In addition, this material was used in a series of experiments to test a new approach to the production of anatomically realistic soft plaques in flow phantoms. Current research into plaque characteristics in Doppler flow phantoms has been limited to the use of wedges of PVA-C which are subjected to more (hard plaques) or fewer (soft plaques) freeze thaw cycles than the surrounding vessel [1] . A novel approach to the production of soft plaques is presented where cod liver oil capsules are embedded in the tissue. Following the production of the flow phantom, the gelatine capsules can be breached and liquefied by placing the entire phantom in a heated water bath; this leaves the cod liver oil encased in the vessel by a thin layer of PVA-C. By replacing the cod liver oil with a soft lipid mimicking fluid, anatomically realistic plaques can be constructed.

The ability to delineate the prostate from surrounding tissue, namely contrast is vital in ultrasound-guided prostate brachytherapy [1] . In order to evaluate this performance criteria a series of volume phantoms with clinically relevant contrasts (−3 dB and −4 dB) were developed and manufactured in-house. Ultrasound-guided brachytherapy for prostate cancer was introduced in 2007 in Ireland [2] and has since been accepted in a number of treatment centres, largely due to benefits for patient recovery [1] . Success of the procedure is based on correct dose estimation and concise implantation of the brachytherapy seeds in the prostate. The purpose of the developed prostate volume phantoms was to assess the impact of varying contrast the on volume calculations which are made for prostate brachytherapy treatment planning. The effect of different image optimisation parameters was also investigated to determine their impact on volume estimation accuracy. The optimised images for contrast resolution and volume accuracy results were compared to those obtained for the default clinical settings. It was found that the use of tissue harmonic imaging THI, improved the volume accuracy by as much as 20% and also gave more consistent volume estimations compared to the default B-mode settings. The −3 dB target proved to be more challenging to delineate compared to that of −4 dB. This study illustrates how clinically relevant contrast challenges the delineation of the targets, and how image optimisation can improve the achievable contrast resolution and thus volume estimation accuracy.

Dynamic contrast enhanced ultrasound (DCE-US) using ultrasound contrast agents (UCA) is a non-invasive method of imaging the microvasculature, employing harmonic signal detection. UCAs are currently used clinically for qualitative visualisation purposes predominately. There is current interest in detecting the subharmonic component, known to be generated by UCAs but not tissue, which may increase sensitivity, although optimal transmission parameters remain to be determined. The aim of this work was to establish an acoustic characterisation system for use in establishing optimal subharmonic parameters. A reflection-based broadband acoustic system for UCA characterisation was developed and used to measure the attenuation of the UCA Definity™ (Lantheus, USA) across the diagnostic frequency range 1–10 MHz. A Coulter counter (aperture size 20 μm) was used to establish the size distribution (1.3–10 μm) and concentration of the UCA (1.2–1.4 × 109 bubbles/ml). Using a pulse-echo substitution method and single element transducer (Olympus, USA) the attenuation was measured of a solution of Definity diluted in saline, made up to an ‘in vivo’ concentration of 800,000 bubbles/ml. Pressure levels and frequency content, which influence the production of subharmonic signal, were also investigated using a through-transmission set-up with a needle hydrophone (Precision Acoustics, UK). A through-transmission narrowband characterization system for use in subharmonic characterization was also developed and pressure levels above the subharmonic threshold of ∼50 kPa were measured. An attenuation of 1.1 dB/cm was measured at 5 MHz, which is close to that reported in literature [1] . The developed broadband and narrowband systems are enabling an in-depth investigation of optimal transmit settings to maximise the subharmonic signal. Acknowledgement Irish Research Council, Government of Ireland Postgraduate Scholarship.

In microwave breast cancer detection, it is often beneficial to arrange sensors in close proximity to the breast. The resultant coupling generally changes the antenna response. As an a priori characterization of the radio frequency system becomes difficult, this can lead to severe degradation of the detection efficacy. The purpose of this paper is to demonstrate the advantages of adopting an interferometric multiple signal classification (I-MUSIC) approach due to its limited dependence from a priori information on the antenna. The performance of I-MUSIC detection was measured in terms of signal-to-clutter ratio (SCR), signal-to-mean ratio (SMR), and spatial displacement (SD) and compared to other common linear noncoherent imaging methods, such as migration and the standard wideband MUSIC (WB-MUSIC) which also works when the antenna is not accounted for.The data were acquired by scanning a synthetic oil-in-gelatin phantom that mimics the dielectric properties of breast tissues across the spectrum 1-3 GHz using a proprietary breast microwave multi-monostatic radar system. The phantom is a multilayer structure that includes skin, adipose, fibroconnective, fibroglandular, and tumor tissue with an adipose component accounting for 60% of the whole structure. The detected tumor has a diameter of 5 mm and is inserted inside a fibroglandular region with a permittivity contrast εr-tumor/εr-fibroglandular1.5 over the operating band. Three datasets were recorded corresponding to three antennas with different coupling mechanisms. This was done to assess the independence of the I-MUSIC method from antenna characterizations. The datasets were processed by using I-MUSIC, noncoherent migration, and wideband MUSIC under equivalent conditions (i.e., operative bandwidth, frequency samples, and scanning positions). SCR, SMR, and SD figures were measured from all reconstructed images. In order to benchmark experimental results, numerical simulations of equivalent scenarios were carried out by using CST Microwave Studio. The three numerical datasets were then processed following the same procedure that was designed for the experimental case.Detection results are presented for both experimental and numerical phantoms, and higher performance of the I-MUSIC method in comparison with the WB-MUSIC and noncoherent migration is achieved. This finding is confirmed for the three different antennas in this study. Although a delocalization effect occurs, experimental datasets show that the signal-to-clutter ratio and the signal-to-mean performance with the I-MUSIC are at least 5 and 2.3 times better than the other methods, respectively. The numerical datasets calculated on an equivalent phantom for cross-testing confirm the improved performance of the I-MUSIC in terms of SCR and SMR. In numerical simulations, the delocalization effect is dramatically reduced up to an SD value of 1.61 achieved with the I-MUSIC in combination with the antipodal Vivaldi antenna. This shows that mechanical uncertainties are the main reason for the delocalization effect in the measurements.Experimental results show that the I-MUSIC generates images with signal-to-clutter levels higher than 5.46 dB across all working conditions and it reaches 7.84 dB in combination with the antipodal Vivaldi antenna. Numerical simulations confirm this trend and due to ideal mechanical conditions return a signal-to-clutter level higher than 7.61 dB. The I-MUSIC largely outperforms the methods under comparison and is able to detect a 5-mm tumor with a permittivity contrast of 1.5.