Real-time volumetric free-hand ultrasound imaging for large-sized organs: A study of imaging the whole spine

Three-dimensional (3D) ultrasound imaging can overcome the limitations of conventional two dimensional (2D) ultrasound imaging in structural observation and measurement. However, conducting volumetric ultrasound imaging for large-sized organs still faces difficulties including long acquisition time, inevitable patient movement, and 3D feature recognition. In this study, we proposed a real-time volumetric free-hand ultrasound imaging system optimized for the above issues and applied it to the clinical diagnosis of scoliosis. This study employed an incremental imaging method coupled with algorithmic acceleration to enable real-time processing and visualization of the large amounts of data generated when scanning large-sized organs. Furthermore, to deal with the difficulty of image feature recognition, we proposed two tissue segmentation algorithms to reconstruct and visualize the spinal anatomy in 3D space by approximating the depth at which the bone structures are located and segmenting the ultrasound images at different depths. We validated the adaptability of our system by deploying it to multiple models of ultra-sound equipment and conducting experiments using different types of ultrasound probes. We also conducted experiments on 6 scoliosis patients and 10 normal volunteers to evaluate the performance of our proposed method. Ultrasound imaging of a volunteer spine from shoulder to crotch (more than 500 mm) was performed in 2 minutes, and the 3D imaging results displayed in real-time were compared with the corresponding X-ray images with a correlation coefficient of 0.96 in spinal curvature. Our proposed volumetric ultrasound imaging system might hold the potential to be clinically applied to other large-sized organs.