Ultrasonography

XView + MView Capabilities

Ultrasound Product Planning

The visual effect given to the user by XView Technology on the ultrasound images, can be quite similar to that of MView. At the eyes of the user both technologies seem to achieve similar results, this quite comparable outcome is anyway achieved by two very different means. XView Technology is a real-time algorithm that provides a significant reduction in speckle. It operates speckle lessening during each one of the stages that covers all the ultrasound image formation process: from the echo acquisition to the visualisation of the image on the screen.

MView technology consists of an ultrasound technique that uses electronic beam steering of a transducer array to acquire several coplanar scans of an object from different view angles, pulses are transmitted both perpendicular to the transducer array and in oblique directions. Different pulses from different angles are co-related to form one final image.

XView Technology – Overview

Ultrasound suffers from an intrinsic imaging artifact called speckle. Speckle is the random grainy texture that obscures anatomy in ultrasound images and is usually described as ‘noise,’ in order to indicate something that dirties the image. Speckle is created by a complex interference of ultrasound echoes made by reflectors spaced closer than the ultrasound system’s resolution limit, degrading spatial and contrast resolution and obscuring the underlying anatomy.

X-View gives the right boost to the US scanner capability of speckle reduction, enabling the system to consider both the acquisition, processing and presentation phase of the diagnostic image on the same common platform, linking the one to the other more closely than in any other approach so far developed by Esaote and competitors. While any other speckle reduction technique is able to treat and to operate only considering one of the three stages (acquisition, image processing, presentation on the screen) at the time, X-View breaks this limit and gives to the system the calculation power and the hardware structure that allows the speckle reduction over all the stages the image has to pass through.

In this new revolutionary Esaote product, the dynamic integration of various stages that constitutes the process that data has to follow from the probe to the screen gives the plus to the entire architecture. Every stage can be influenced and can influence the other phases, in order to obtain the best possible result.

Dynamic optimisation process of XView technology can be described as follows:

Intelligent: The image is deeply analysed. The system recognises the portion of the image affected by speckle treating it in a different way with respect to the part of the image that carries information.

Adaptive: The acquisition stage can be adjusted in order to obtain the best possible information that could be processed during the following processing stages.

Optimised: Speckle is removed while the information necessary for the diagnostic image is conserved and enhanced in order to optimise the result. Processed image data from both the portion of the image affected by speckle and the portion carrying the necessary information are combined to reconstruct the entire image. The result is an image that preserves the original image feature, while suppressing the speckle contents.

The intelligent and adaptive nature of X-View allows it to smoothen regions where no feature or edges appear and maintain or enhance edges and borders. X-View increases contrast resolution by increasing the signal to noise ratio. It does not eliminate any information, so diagnostic criteria is preserved. Only ‘noise’ is removed while information is preserved and enhanced. A significant increase in image quality, a more interesting clinical image concerning the diagnostic point of view.

M View Technology – Overview

MView Technology is a new approach of Esaote to solve the Ultrasound imaging problems of speckle, artifacts, shadowing and not perfectly insonated structures (typical is the case of tendons).

It consists of an ultrasound technique that uses electronic beam steering of a transducer array to acquire several co-planar scans of an object from different view angles.

MView is a spatial compounding technique. Pulses are transmitted both perpendicular to the transducer array and in oblique directions. Different pulses from different angles are correlated to form one final image. The technique gives to the user the possibility to obtain enhanced contrast resolution with better tissue differentiation and clear organ borders and structure margins visualisation. Tissue layers and vessel walls are more clearly differentiated for an enhanced visualisation, nodules appear with less acoustic shadowing and higher definition of borders.

The ability of MView technology to improve image quality is mainly due to suppression of image artifacts. Scanning from different angles produces different artifact patterns. Adding these independent frames to form a single final image, suppresses speckle and reinforces real structures.

Implementation

How XView Technology is implemented on MyLab25/30 and MyLab50? The XView algorithm gives to the user the possibility to choose between three different levels of image optimisation in order to obtain the best possible image depending on the application and the particular image considered. Two levels of image optimisation are already set by the Factory.

The third level of optimisation gives the user the possibility to change three parameters of the image:

XSmooth, XDetail and XEnhancement. XSmooth range is from 1 to 5, XDetail range is from 1 to 8, XEnhancement range is from 1 to 12. With proper soft keys the user has the possibility to change the characteristics of the image displayed on the screen. XSmooth regulation flattens the ‘noise’ that affects the image. XDetail enhances the details of the contours, curves, edges and structures present in the information that constitutes the image, enabling the end user to view even the minimum characteristics and particulars. XEnhancement maximises the information that enables the end user to visualise in the best possible way the information related to the structures already emphasized with the previous steps.

X-View C gives the user the possibility to completely customise the XView technology in order to get the best possible diagnostic evidence from the acquired images. This overcomes the problem of having a beautiful image but really poor from the diagnostic point of view.

The possibility to set XSmooth, XDetail and XEnhancement maximise the user confidence in the acquired images. XView C soft key with XSmooth, XDetail and XEnhancement sub-levels X-View Technology is the only speckle reduction technique, available on the market, that enables the user to fine tuning diagnostic images optimisation. XView gives an important plus to MyLab25/30/50 ultrasound scanners, allowing them to be re-positioned in an higher market segment. The added value given by the XView Technology represents a huge quality step concerning the 2D B-Mode information enhancement and speckle reduction.

More information is obtained, the minimum possible level of speckle affects the image, especially concerning applications such as obstetrics/ gynaecology, abdominal, vascular, breast, thyroid and musculo-skeletal the quality of image improvement obtained by the use of XView technology gives to the end-user an impressive plus with respect to the readability of the image and with respect to the diagnostic confidence. Moreover, the XView technology can help a lot the end user in the definition of the endocardial borders for the utilisation of the XStrain post processing algorithm. Better the endocardium is defined, better the user can fix the points for the measurement of strain and strain rate of the patient left ventricle.

XView feature is available within all the applications and all the probes. Also when TEI and/ or MView are on. XView technology is only not available when the Tools Stress Echo and Concurrent visualisation modality (that is, when the size of the 2D B-Mode image is the same of the CFM box) are active. With software release 8.0 (for MyLab25/30 and MyLab50) XView is also available within 3D/4D modality.

How MView Technology is implemented on MyLab25/30 and MyLab50 MView boosts the compound imaging capabilities already present in other competitors ultrasound system to a higher level. Coplanar, tomographic images from different viewing angles are combined into a single compounded image. Up to 15 different viewing angles can be achieved in the same image.

Variable steering angles can be chosen by the user changing the MView level (from 1 to 10) using the proper soft key. Increasing the MView level also the number of viewing angles increases. MView soft key when MView is on, the soft key density changes its meaning with respect to usual, conventional 2D B-Mode images.

When MView Technology is active, density refers to the kind of algorithm used for the reconstruction of the final image, starting from the different coplanar, tomographic images taken by various viewing angles. When density is low, the algorithm is the average/ maximum. When density is high, the reconstruction algorithm is the maximum one.

Density Soft Key

High and low levels. How MView can be chosen by the user on MyLab25/30 and MyLab50 ultrasound scanners. MView levels 6,7, 9 and 10 are mostly indicated for the evaluation of superficial structure, due to the utilisation of viewing angles with absolute values greater than ±12. In the area near the probe MView 6, 7, 9 and 10 maximise spatial resolution and speckle reduction, even if they can create some minor artifacts in a deeper part of the echographic image, usually far from the actual area of interest.

All the other MView levels (1, 2, 3, 4, 5 and 8) can be used for every kind of echographic image— They do not create any kind of artifact, increasing spatial resolution and speckle reduction uniformly in every part of the image.

How the user can chose the algorithm that combine the different viewing angles echoes on MyLab25/30 and MyLab50 ultrasound scanners: With the algorithm Maximum, the maximum grey scale level value that the same pixel has with respect to all the frames (obtained by different steering angles of the ultrasound beam) that compose the final image, is shown to the user. Algorithm maximum enhances spatial resolution of structures.

With the algorithm Average/ maximum the maximum and the medium grey scale level value that the same pixel has with respect to all the frames (obtained by different steering angles of the ultrasound beam) that compose the final image, are averaged and shown to the user. Average/Maximum Algorithm enhances speckle reduction. MView Technology on MyLab25/30 and MyLab50, is available on the following probes: LA523, LA435, LA332, LA522, TRT33 (only Linear Array), LP323, IOE323 Combined use of MView and XView technologies. The combined use, at the same time, of XView Technology— Adaptive multistage image enhancement - and MView technology – Spatial Compound Imaging, gives to the user a superior ultrasound imaging quality that extremely increases diagnostic confidence and image readability.

XView Technology gives to MyLab25/30 and MyLab50 Esaote Ultrasound scanners the possibility to dramatically reduce speckle while increasing the diagnostic information of the image, without any loss in frame rate, within all the Applications and using all the probes. XView can be on also when Vpan, 3D/4D, TEI and MView are active. It gives a significative plus to the diagnostic confidence of the user especially because the really high freedom offered by the possibility to fine tuning the image optimisation using XView C and its sub-levels XSmooth, XDetail and XEnhancement.

The most important advantages by the use of XView technology can be clearly visible in applications such as obstetrics/ gynaecology, abdominal, vascular, breast, thyroid and musculo-skeletal. Moreover XView Technology can help a lot the end-user in the definition of the endocardial borders for the utilisation of the XStrain post processing algorithm. MView Technology is a powerful spatial compound technique that enables the user to look the same tomographic view of the body from up to 15 different directions. This entails a lowering of the presence of artifacts and general speckle reduction, that influence the image diagnostic quality.

Moreover, the user has the possibility to change the kind of Algorithm that merges together the different frames obtained by different points of view, simply changing the density soft key, choosing between high and low which correspond to the maximum and average/ maximum algorithm.

Musculoskeletal

MView Technology has its most interesting purpose concerning musculoskeletal application (tendon, shoulder, muscle, hand), thyroid, breast, small parts (testis) and vascular (arteriosclerotic plaques and vessel walls).

MView Technology has the disadvantage of entail a frame rate lessening. Anyway, because MView has its most important use concerning clinical applications that don’t deal with fast movements of body structures, this reduction doesn’t affect in any case the user diagnostic confidence with respect to the body district under examination

MView Technology adds to XView real-time algorithm, an empowerment at the level of the insonation performed by the probe. MView is the part that is missing to XView in order to optimise all the complete process of the ultrasound image formation— not only from the acquisition level to the visualisation on the screen, passing trough the processing phase, MView acts at the level of insonation, in the way the ultrasound beam is generated by the transducer array. MView acts at the level of how the ultrasound beam is generated, XView considers all the other stages that remain between the probe and the final user. Those technologies used together enable the user to have a completely new approach to ultrasound. Each stage from the ultrasound beam generation, till the visualisation on the screen of the diagnostic image to the end user is optimised and enhanced.

XView has the values 1, 2 or C. XView C has three sublevels. MView has nine different levels, each one related to the maximum or average algorithm. This great freedom enables the user to have its really customised image optimisation. MView and XView soft-keys are all on the same level of the soft key menu of MyLab25/ 30 and My Lab50 Esaote Ultrasound scanners. The result is that the combination of MView and XView achieves a considerable reduction in speckle and artifacts that affect the final image, while also enhancing diagnostic information.

MView and XView applied together to the same image generate a superior quality ultrasound image, characterised by a higher diagnostic value. The image quality generated with XView and MView Technologies helps the user to diagnose with greater confidence: enhanced diagnostic confidence and higher readability of the ultrasound diagnostic images is guaranteed.

Combined use of MView and XView Technologies– Some echographic images of tendons are shown in the following figures. Due to its particular echogenicity (tendons are completely visible only if insonated perpendicularly), tendon is the best body structure in order to clearly show the capabilities offered to the user by the combined use of MView and XView technologies.