Method of detection of microcalcifications by ultrasound

Abstract

Methods and devices for imaging of microcalcification particles using ultrasound. The method may include delivering a multi-pulse transmit packet of an acoustic line to a predetermined location within a tissue having or suspected of having a microcalcification; causing the microcalcification to move or oscillate, comparing one or more received signals from the location over multiple transmissions, and determining frequency modulation of the returning pulses as a result of the microcalcification oscillation or random pattern movement.

Claims

1. A method of visualizing a microcalcification in a tissue or organ of a mammal using ultrasound imaging technology comprising: providing a transmit packet of at least one ultrasound generated pulse to a location within a tissue or organ of a mammal; providing an ultrasound image representing a microcalcification in said tissue or organ of a human being; displaying, on a display device, an image representing a microcalcification within said location of a tissue or organ of said mammal.

2. The method of visualizing a microcalcification in a tissue or organ of a mammal using ultrasound imaging technology according to claim 1, comprising: providing a transmit packet of one or more pulses.

3. The method of visualizing a microcalcification in a tissue or organ of a mammal using ultrasound imaging technology according to claim 1, wherein said mammal is a human.

4. The method of visualizing a microcalcification in a tissue or organ of a mammal using ultrasound imaging technology according to claim 1, wherein said tissue or organ is breast tissue.

5. The method of visualizing a microcalcification in a tissue or organ of a mammal using ultrasound imaging technology according to claim 1, wherein said transmit packet of at least one pulse is sufficient to cause said microcalcification to oscillate or move in a random pattern.

6. The method of visualizing a microcalcification in a tissue or organ of a mammal using ultrasound imaging technology according to claim 1, further inducing the step of determining a frequency modulation of said retuning pulses as a result of said microcalcification oscillation or random or controlled pattern movement.

7. A method of determining the existence of a microcalcification in a tissue using ultrasound comprising: delivering a one or more pulse transmit packet of an acoustic line to a predetermined location within a tissue having or suspected of having a microcalcification; if within said tissue a microcalcification is present, exciting said microcalcification to create random or controlled movements; and comparing one or more received signals from said location over multiple transmissions.

8. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 7, further including a step of a determining frequency modulation of returning pulses as a result of said microcalcification oscillation or random or controlled pattern movement.

9. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 8, further including a step of providing an ultrasound image representing said microcalcification in said tissue.

10. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 7, further including the step of determining differences of said acoustic line at a point of said microcalcification.

11. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 10, wherein said determining of differences of said acoustic line at the point of said microcalcification includes subtraction of said acoustic lines.

12. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 10, wherein said determining of differences of said acoustic line at the point of said microcalcification includes cross correlation, cross covariance, pulse inversion, autocorrelation, Frequency domain operations, Doppler variance metrics, or difference of squares.

13. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 7, wherein said multi-pulse transmit packet includes one or more pulses per transmit packet.

14. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 13, wherein said multi-pulse transmit packet includes at least 1 pulse per cycle.

15. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 13, wherein said multi-pulse acoustic packet includes at least one pulse.

16. A method of detecting microcalcification within breast tissue using ultrasound imaging technology comprising: providing an acoustic pulse generated by an ultrasound device to a predetermined location within breast tissue; exciting said microcalcification to create random or controlled movements or oscillations; comparing one or more received signals from said location over one or more transmissions; and providing an ultrasound image representing a microcalcification in said breast tissue.

17. The method of detecting microcalcification using ultrasound imaging technology according to claim 16, wherein said step of providing said acoustic pulse generated by an ultrasound machine to a predetermined location includes multiple pulse cycles.

18. The method of detecting microcalcification using ultrasound imaging technology according to claim 17, wherein said step of providing said acoustic pulse generated by an ultrasound machine to a predetermined location includes one or more pulse cycles.

19. The method of detecting microcalcification using ultrasound imaging technology according to claim 16, wherein said step of providing said acoustic pulse generated by ultrasound machine to a predetermined location includes one or more pulse cycles.

20. The method of determining the existence of a microcalcification in a tissue using ultrasound imaging technology according to claim 7, further including a step of a determining differences in the returning signals as a result of changing the acoustic power interacting with said microcalcification, through variations in one or more of the transmit voltage, waveform, focal point spatial location, focus quality, aperture size, subaperture variations, phase, jitter, etc.

Description

BRIEF DESCRIPTION OF THE FIGURES

[0043] The patent or application contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawings will be provided by the Office upon request and payment of the necessary fee.

[0044] FIG. 1 is a schematic representation of an illustrative example of an imaging system for visualizing microcalcifications using ultrasound;

[0045] FIG. 2A is an illustrative embodiment of a process for visualizing microcalcifications;

[0046] FIG. 2B is an illustrative embodiment of a process for visualizing microcalcifications;

[0047] FIG. 2C is an illustrative embodiment of a process for visualizing microcalcifications;

[0048] FIG. 3 illustrates an acoustic line of an agar phantom filled with corn starch to provide backscatter;

[0049] FIG. 4 illustrates an acoustic line of an agar phantom filled with corn starch to provide backscatter with a microcalcification;

[0050] FIG. 5 illustrates a magnified view of an acoustic line at the point of the microcalcification;

[0051] FIG. 6 illustrates a B-Mode Image fused with a CA-Mode Image of a piece of fat and muscle;

[0052] FIG. 7A illustrates digitization of an acoustic line;

[0053] FIG. 7B illustrates subtraction of two acoustic lines separated by 200-microseconds;

[0054] FIG. 8 illustrates a B-Mode Image fused with a CA-Mode Image of a microcalcification in front of a boundary layer;

[0055] FIG. 9 illustrates a piece of pork with microcalcifications placed in a cut;

[0056] FIG. 10A illustrates one of the stages of the interaction of the transmit pulse packet and the microparticle;

[0057] FIG. 10B illustrates one of the stages of the interaction of the transmit pulse packet and the microparticle;

[0058] FIG. 10C illustrates one of the stages of the interaction of the transmit pulse packet and the microparticle;

[0059] FIG. 10D illustrates one of the stages of the interaction of the transmit pulse packet and the microparticle;

[0060] FIG. 10E illustrates one of the stages of the interaction of the transmit pulse packet and the microparticle;

[0061] FIG. 11A illustrates the effects of the counter-propagating waves proximal to the microcalcification;

[0062] FIG. 11B illustrates the effects of the counter-propagating waves proximal to the microcalcification;

[0063] FIG. 12 is a description of the processes in pulse inversion harmonic imaging;

[0064] FIG. 13A illustrates different colored RF acoustic lines (eight) showing a microcalcification signal (left), followed by a boundary layer of greater acoustic reflective power (right);

[0065] FIG. 13B illustrates the color-coded subtraction results of the eight acoustic lines (line 1line 2, line 2line 3, line 3line 4 . . . line 7line 8) shown in FIG. 11A in the same location; the magnitude of the difference between lines is significantly higher than anywhere else, even at the boundary where the echo amplitude is significantly higher;

[0066] FIG. 13C illustrates an expanded section of the demodulated and filtered fundamental form for the acoustic lines gathered for FIG. 11A at the microcalcification, showing both the microcalcification and the border behind it;

[0067] FIG. 13D illustrates the demodulated and filtered second harmonic from the acoustic lines gathered for FIG. 11A at the microcalcification, showing both the microcalcification and the border behind it;

[0068] FIG. 14 illustrates an image from which the acoustic line was selected in FIGS. 11A-11D, showing the B-Mode in grayscale and the QA-Mode in red;

[0069] FIG. 15 is a description of the non-inotropic backscatter from a particle approximately the same size as the incident wavelength of the insonification;

[0070] FIG. 16 illustrates the effects of increasing transmit power and its effect on chaos; and

[0071] FIG. 17 illustrates the effects of changing the focal location relative to the microcalcification and its effect on the chaotic oscillations.

DETAILED DESCRIPTION OF THE INVENTION

[0072] While the present invention is susceptible of embodiment in various forms, there is shown in the drawings and will hereinafter be described a presently preferred, albeit not limiting, embodiment with the understanding that the present disclosure is to be considered an exemplification of the present invention and is not intended to limit the invention to the specific embodiments illustrated.

[0073] Many organs and parts of the body are comprised of soft tissue superior to the bone structure such as breast, thyroid, and liver. Medical ultrasound is used diagnostically to examine and diagnose diseases and conditions in soft tissue. Ultrasound is the predominant method of visualizing the morphology in soft tissues, and it depends on differences encountered at variations in the density, speed or sound (acoustic impedance) at cellular and organ boundary interfaces, which is a property of the tissue.

[0074] Acoustic impedance (Z) depends on the density of the tissue (which may be expressed in kg/m3) and the speed of the sound wave (usually expressed in m/s), and they are related by Z=pc and is described as how much resistance an ultrasound beam encounters as it passes through tissue.

[0075] An ultrasound transmit pulse's ability to transfer from one tissue type to another depends on the difference in impedance of the two tissues. If the difference is large, then more of the transmit pulse's energy is reflected.

[0076] The amount of reflection that occurs is expressed by: Reflection fraction (percentage)=[(Z.sub.2Z.sub.1)/(Z.sub.2+Z.sub.1)].sup.2, where Z.sub.1 and Z.sub.2 represent the impedance in tissue 1 and tissue 2, respectively.

[0077] Examples of acoustic impedance for organs of the body are: fat 1.3410.sup.6, water 1.4810.sup.6, kidney 1.6310.sup.6, blood 1.6510.sup.6, liver 1.6510.sup.6, muscle 1.7110.sup.6, and bone 7.810.sup.6.

[0078] From the equation above, less than 1% of sound is reflected at a fat-liver interface and 47% is reflected at a muscle-bone interface or a microcalcification.

[0079] If the sound wave is not perpendicular to a surface, some of the sound wave will be reflected away from the transducer in accordance with Snell's law.

[0080] In a breast, the only variations in acoustic impedance is expected to be minor between the pectoral muscles, ligaments, fat, and glandular tissue which present a variation of 1.34 to 1.71, or as shown above to be less than 1% of the incident energy reflected at these interfaces.

[0081] Macrocalcifications, which are defined here to be greater in size than 200-microns, are results of aging, milk production, vascularization changes or past trauma, and are made of calcium oxalate, have a density of approximately 2, are randomly dispersed, and have been found to be not an indication of cancer. The visualization of macrocalcifications can be minimized or eliminated by setting thresholds in the difference values, and will not be confused with microcalcifications.

[0082] In B-Mode (amplitude-based image formation), due to the microcalcifications density (>4) and speed of sound (>8000) will reflect 47% of the energy impinging on the microcalcification. However, the microcalcification's small physical size will reduce its visibility on B-Mode scan in the midst of all the other structure interfaces present in the breast. Microcalcifications can be seen, but the background from the other interfaces is high, so ultrasound is currently not used for microcalcification detection.

[0083] The 47% reflection at the microcalcification imparts a momentum into the microcalcification. Due to the momentum not being absorbed but reflected, this momentum is doubled, and is imparted into a relatively small particle. Utilizing acoustic radiation levels that are used and approved by regulatory agencies for B-Mode imaging, it has been found that a microcalcification can be seen to be physically moved by this transfer of momentum, and this can appear to be a positional change on the order of nanometers to microns.

[0084] If the Transmit Wave Packet comprises multiple Transmit Pulses, the reflection of the latter pulses of this wave packet will be modulated by the positional movement of the particle from the earlier pulses.

[0085] This modulation may be thought of as a spring-loaded pendulum, whereby slight variations in position, timing, phase, power, amplitude, jitter or other characteristics of the particle or transmit wave have enough variation to cause instability to manifest in a measurable chaos in the returned signal. In the preferred embodiment, this difference is summed from multiple pairs of insonifications, though it can also be measured in a single insonification.

[0086] As an illustration only, a 4 MHz packet of four contiguous sine waves will be in tissue (approximate speed of sound of 1540 meters per second) (=v/f) 375 microns per cycle greater than 1500 microns for the wave packet, or expressed in time as a 1-microsecond aberration, i.e. the particle will move in response to the first cycles, and this can be observed by the later cycles as shifted in position. So, the latter cycles of the transmit wave packet may be frequency modulated by the movement of the particle from the energy imparted by the first cycles of the ensemble. This is of interest as, in the soft tissues of the breast, there are no other mechanisms to cause any abrupt aberration of transmit packet or harmonics generated by the wave's transmission.

[0087] Harmonics are generated by the high-pressure portion of the wave traveling faster than the low-pressure portion, resulting in distortion of the shape of the wave. This change in waveform leads to the generation of harmonics (multiples of the fundamental or transmitted frequency) from a tissue. These harmonic waves that are generated within the tissue increase with depth to a point of maximum intensity (focus point) and then decrease with further depth due to attenuation. This generation of harmonics is continuous and not an abrupt disturbance as described above as occurring at a microcalcification.

[0088] The immediate environment of the microcalcification is also expected to be complex in that microcalcifications are known to form on the surface of a duct lobule (milk producing structure) against other breast structures. Its spring structure is not expected to be isotropic, and its movement is not expected to be in the direction of insonification. Thus, the microcalcification, if interrogated within its damped vibrational period, will not be expected to be in the exact same location as its first insonification by an interrogating pulse.

[0089] Also, at the microcalcification, the reflection is as shown above to have 47% of the energy of the incoming ultrasonic wave. In a packet of multiple waves, the latter pulses are expected to first encounter the reflected earlier pulses of the packet in the space just proximal to the microcalcification. This is a space which could be described as a volume of counter propagating waves. Here, the reflections of the earlier pulses will interfere with the later pulses of the transmit wave packet. This space is defined by the frequency of the pulse packet and the number of pulses in the packet. This space may be extended by extending the number of cycles in the transmitted packet. At points where a compression from an incoming sine pulse coincides with a reflection compression, the compression will be amplified so the pulse will have a higher speed of sound. Similarly, with rarefactions and compressions interacting with rarefactions, the interaction will be complex and be expressed in the time of flight of the received echoes from that point. This interaction is dependent on so many microscopic factors it could be best described as a point of chaos. We have not found, and would not expect to find, the same data from this location, even if that time between acoustic lines is less than 100-microseconds.

[0090] Thus, we have not found any set of two acoustic lines which intersect the microcalcification to have the same backscatter at the point of the microcalcification, or just proximal to the microcalcification, when enough power has been used to excite the microcalcification. The microcalcification may be modeled by thinking of it as a hard spherical particle held in its position by multiple springs to the surrounding tissue with no isotropic features. This is the equivalent to the model of the double or multiple pendulum chaos. This chaos appears to exist for about a microsecond. Providing nothing is spatially moved, all points in the rest of the acoustic lines are identical in multiple samplings.

[0091] The problem of visualizing microcalcifications is solved by exciting the locations of the microcalcification, by a multi-pulse transmit or acoustic packet of an acoustic line, into an excited chaotic state and comparing the received signal from a given spatial location over multiple transmissions. The acoustic lines will differ at the point of the microcalcification. The comparisons are best found by simple subtraction of the acoustic lines, but other methods used include cross correlation, pulse inversion, autocorrelation, Frequency domain, doppler variance metrics, difference of squares, etc. The preferred embodiment is subtraction due to simplicity and speed. The methods of visualizing and/or detecting microcalcification described herein may be used or applied to any tissue, such as a breast tissue, organ, or other anatomical structure where possible of a mammal, preferably a human. It is also noted that while the methods and devices are described as visualizing and/or detecting microcalcificatio, other microparticles may be detected as well.

[0092] The transmit packet of multiple pulses may include a single pulse, which is a lower signal to noise, up to 32 pulses, and currently four pulses is the preferred embodiment. The frequency of the transmit pulse is dependent on the transducer characteristics. For microcalcification particles of 100 to 200 microns, 4-5 MHz fundamental transmit frequency creating a second harmonic of 8-10 MHz may be optimal for power, penetration and having the most interaction with the particles. Interaction with a 100-200-micron particle may be optimized with a wavelength that is approximately of these dimensions. A powerful transmission of a relatively low frequency of 4 MHz can be focused to any depth in the breast, generating harmonics which will add to the interaction with the microcalcification.

[0093] FIG. 1 is a schematic representation of an illustrative example of an imaging system for visualizing microcalcifications using ultrasound, referred to generally as microcalcifications imaging and detection system 10. The microcalcifications imaging and detection system 10 may include one or more of the following, in any combination of components: an ultrasound imaging unit 12, a computing system 14 for receiving or processing ultrasound images, and a display unit 16. It is noted that any of the components of the microcalcifications imaging and detection system 10 can operate via wired or wireless connections.

[0094] Ultrasound technology is well known in the art, and any imaging device known to one of skill in the art may be used. The ultrasound imaging unit 12 may include a transmitter 18, such as one or more electro-acoustic elements for transmitting acoustic energy and a receiver 20, such as one or more electro-acoustic elements receiving acoustic energy. The one or more electro-acoustic elements may be, for example, a piezoelectric ceramic (pzt or other piezoelectric compounds, can be single crystal or composite), or polymer, such as Polyvinylidene fluoride or polyvinylidene difluoride (PVDF), a capacitive micromachined ultrasonic transducers (CMUT) or movable electrode in piezoelectric ultrasonic transducers (PMUT), or even electro-magnetic like a speaker, etc., any transducer capable of converting electric or magnetic energy into acoustic waves and some receiver capable of converting sound waves into electric signals. These can vary in size, shape and frequency. This can be done with a single element or array of elements. Arrays can be annular, linear, convex, concave, 1d, 1.25d, 1.5d, 1.75d, 2d arrays (multiple rows of elements), etc.

[0095] The computing system may include a computer having a processor 22, memory/storage 24, software 26, and any other hardware necessary to perform preferred functions such as, but not limited to, microcalcification detection. The memory/storage 24, and/or software 26 may include the necessary instructions for microcalcification detection. The processor may include general purpose central processing unit(s), application specific processors, and logic devices, as well as any other type of processing device, or combinations or variations thereof. Instructions for microcalcification detection can direct the processor 22 to carry out any of the processes described herein.

[0096] The memory/storage 24 may include any computer readable storage media readable by the processor 22 and capable of storing software 26, including instructions for microcalcification detection. Memory/storage 24 may include volatile and non-volatile, removable and non-removable media, implemented in any method or technology for storage of information, such as computer readable instructions, data structures, program modules, or other data. Illustrative examples of the memory/storage 24 may include storage media, including random access memory (RAM), read only memory (ROM), magnetic disks, optical disks, CDs, DVDs, flash memory, solid state memory, phase change memory, or any other suitable storage media. Certain implementations may involve either or both virtual memory and non-virtual memory. In no case do storage media consist of transitory propagated signals. In addition to storage media, in some implementations, the memory/storage 24 may also include communication media over which software may be communicated internally or externally. The memory/storage 24 may be implemented as a single storage device, but may also be implemented across multiple storage devices or sub-systems co-located or distributed relative to each other.

[0097] The microcalcifications imaging and detection system 10 and methods thereof may further include a database 28 having one or more ultrasound images stored therein. The microcalcifications imaging and detection system 10 may include Input/Output devices 30, such as a keyboard, mouse, joystick, light pen, scanner, touchscreen. The display unit 16 may include a monitor or a visual display unit, such as an LCD monitor. The microcalcifications imaging and detection system may be configured as a single stand-alone unit. Alternatively, the microcalcifications imaging and detection system 10 may be part of a network of connected computer systems or other computing machines, including as part of servers or cloud based computing systems. The microcalcifications imaging and detection system 10 may be a single desktop computer, a laptop computer, a tablet, a phone, a server, or any other machine capable of executing a set of instructions (sequential or otherwise) that specify actions to be taken by that machine, as well as multiple machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methods described herein.

[0098] The microcalcifications imaging and detection system 10 and methods thereof may include or be configured to utilize a microcalcification identifier circuit. The microcalcification circuit may include digital/analog processing done to differentiate the background tissue from the microcalcification. Such processing is preferably done in software on digital signal recordings, but may be accomplished in the analog domain. In a preferred embodiment, the simplest form would be digitizing the echo signals from a given spatial location from two or more transmit events, and then taking the magnitude of the subtraction of the RF signals. This can be similarly achieved through many mathematical operations on the same echo data, such as by correlations, phase, or amplitude differences, and can be performed on demodulated data, frequency domain data, beam formed or channel data. This can be done by taking the eigenvalues of the covariance matrix of the received RF lines or channel data and comparing the relative magnitudes of the dominant eigenvalues, such as a ratio of the magnitude of the first and second eigenvalues, or comparing the angle of the eigenvectors from covariance matrices from different groupings of the data.

[0099] The microcalcifications imaging and detection system 10 may include or be configured to utilize a microcalcification identifier circuit that uses the estimated magnitude difference to distinguish microcalcifications from background using one or more of:

[0100] 1. The magnitude of the difference in amplitude between signals or combinations of signals from the same location or delay. The magnitude of the difference can be determined as the absolute value of line 1 sample 1line 2 sample 1. The magnitude of the difference can be determined as the ratio of amplitude difference between the eigenvalues from the covariance matrix from difference groupings of signals received from the same spatial location. The magnitude of the difference can be determined as the amplitude difference between the demodulated signals, or can be the amplitude of the derivative of the phase between frequency components.

[0101] 2. The magnitude of a phase or frequency shift between signals or combinations of signals from the same location or delay. This can be mathematically represented by phase information from a Hilbert transform, an autocorrelation, frequency domain transform (Fourier, Hartley, z), demodulation, etc., however the phase will change as the particle moves relative to the incoming acoustic waves and background tissue.

[0102] 3. The magnitude of the difference between sets of difference data from the same receive location or delay from different transmit frequencies and or locations. This difference determination may be performed to distinguish from background variation levels in tissue or blood causing false positives. For instance, a transmit packet can be focused to one location near the microcalcification, and then somewhere spatially different, or with different frequencies, or sub-apertures, or power levels, etc. The power applied to sub-aperture sections could be changed to impart a different insonification power vector to get the microcalcification to oscillate in different directions to induce a difference in the received signal. This can be used to distinguish large boundary echoes, blood flow, or blood vessels from smaller particles, as the particle exhibits a much higher variation between received data sets when the transmit power is highly focused at it vs. other background tissues. A boundary layer in tissue or small blood vessel would be a smooth ramp in the magnitude of the difference between difference signals, while a microcalcification or small particle would exhibit a large change in the magnitude difference between difference signals when the power in the acoustic wave is changed. The power can be modulated by changing the pulse characteristics, such as aperture, voltage levels, applied waveforms, sub-aperture variations, focal point spatial location, etc.

[0103] 4. The magnitude of the difference in amplitude or phase of signals in the time or frequency domain from multiple transmissions. Taking the difference in amplitude of the signals can be a simple subtraction of the amplitude values in the RF, or demodulated data, or frequency domain data. The difference in phase can be taken by subtracting the phase between repeats, i.e. phase=arctan (I/Q), like the variance in a Doppler processor. The I and Q can be RF, or demodulated or frequency domain representations, or eigenvectors of the covariance matrix, etc.

[0104] 5. The magnitude of the difference in amplitude or phase of signals in the time or frequency domain from a single transmission where the signals are separated in frequency, such as the fundamental vs. harmonic, or multifrequency transmissions such as a chirp, or multiple elements emitting different frequencies. The difference in the amplitude or phase values can be performed by taking the echo signals corresponding to one or more cycles of the transmit, and then comparing them to other cycles of the transmit. EG 8 cycles (c1, c2, c3, c4, c5, c6, c7, c8) can then be compared to the amplitude and/or phase information from varying cycles, such as the difference in amplitude from cycle 1 to cycle 8, or the ratio of power in the fundamental and harmonic signals from cycle 1 and 8, or groupings of cycles (c1c2 vs. c3c4, c1c3c5c7 vs. c2c4c6c8, etc.)

[0105] 6. The magnitude of the difference in amplitude or phase of signals acquired from different transmit events at varying power levels. For example, transmit a packet at power level 1 and receive the echo data, and transmit a packet at power level 2 and receive the echo data. Then, taking the difference in amplitude or phase between received signals, or between groups of signals. A preferred embodiment might include taking multiple transmit receive data points at each power level and comparing the magnitude of the differences between the power levels. The power levels may be interleaved to reduce temporal artifacts such as pulsatile blood flow or vessel wall motion, i.e. p11, p21, p12, p22. The difference can then be calculated in many ways such as abs(p11-p12)abs(p21-p22) or as a ratio abs(p11-p12)/abs(p21-p22), etc. The power can be changed by altering any of the multiple characteristics of the transmit such as voltage, phase, aperture, drive current, sub aperture patterns, waveforms, frequency, focus point, etc.

[0106] 7. The magnitude of the difference in amplitude or phase of signals acquired from different transmit events with the aperture divided into one or more sub-apertures with varying phase, amplitude or frequency. For example, change the f number (aperture size), change the focus spatial location, split the aperture into sub apertures and change the waveform, phase, delays, pulse width modulation, phase jitter, voltage levels, current drive levels, etc. A transmit aperture could be increased or decreased even 1 element on a sub aperture, and then move that decrease around on different elements to get the microcalcification to oscillate differently. This may be accomplished by hitting the microcalcification with more power on one side, causing it to oscillate in that direction more. The pattern can then be changed to impart more power on the other side to get it to oscillate in a different direction to increase the difference in received signal.

[0107] 8. The magnitude of the difference in amplitude or phase of signals acquired from different transmit events with a jitter or phase or timing or amplitude variation on different elements or sub apertures. This can be accomplished by slight variations in the transmitted signal, which cause oscillations to significantly differentiate the received signal. At 4 MHz, transmit signal jitter of 100 picoseconds between elements would correspond to 0.04% timing variation. This can be induced intentionally by changing the transmitted waveforms amplitude phase or delay.

[0108] 9. The magnitude of the difference in amplitude or phase of signals corresponding to the same spatial location in the tissue acquired from different transmit focus depths or lateral locations or directions. Beam steering can be digitally accomplished on an array, where an operator can focus a transmission in the same location but have it originate from a different spatial aperture. The microcalcification exhibits significant oscillation differences based on the transmission, so transmitting to a focal point spatially different can induce large changes in the magnitude difference at the same receive point. Multi line receive beam formers can create and receive data from multiple spatial locations from any transmit location or pattern. Taking the difference of the magnitude difference as the transmit focus is spatially moved closer or further from the receive point is a good way to discriminate the microcalcifications. For example, transmitting to a location close to the microcalcification will cause it to oscillate more than transmitting to a location further away, and the difference in the oscillation is much larger than for other tissue boundaries. If there are two spatial locations and the microcalcification is located at spatial location 1, focusing the transmit at location 1 will result in large variations between repeats of the acoustic line. If the system or an operator focuses at location 2, the variations will rapidly decay based on the relative power insonifying location 1.

[0109] 10. The ratio or magnitude of the differences between sets of magnitude differences in amplitude or phase of signals from the same or different transmit characteristics such as power, jitter, frequency, focal depth, sub-aperture characteristics such as power, phase, frequency, jitter, etc. This may be accomplished by, for example, focus at location 1, transmit packet with power level 50, repeat multiple times to get a difference signal, focus at location 1, transmit packet with power level 100, repeat multiple times to get a set of difference signals. Compare the ratio of the amplitude of the difference signals between transmitted power levels. This can be done by changing power levels, waveforms, frequencies, aperture size, sub aperture characteristics, etc.

[0110] 11. A signal processor circuit that forms an image or matrix based on the acquired data, wherein the signal processor circuit identifies the distinguished microcalcifications on an image or in a matrix or spatial location.

[0111] The microcalcifications imaging and detection system 10 and methods thereof may include or be configured to utilize one or more echo signatures to form a mapping of the detection of a microcalcification in a given location. The microcalcifications imaging and detection system 10 and methods thereof may include or be configured to utilize two or more echo signatures to form a difference magnitude image or mapping of the detected microcalcifications superimposed on top of a B-Mode image or by itself.

[0112] The microcalcifications imaging and detection system 10 and methods thereof may include or be configured to utilize the ultrasound imaging unit 12 to acquire channel data from one or more receive channels via ultrasound received on the one or more channels.

[0113] The microcalcifications imaging and detection system 10 and methods thereof may include or be configured to utilize a difference factor determinator, using the acquired data to estimate the signal variation in the data from a given spatial location in frequency or amplitude or phase or time. The difference factor determinator may use a threshold on the difference signals or ratio of difference signals. The threshold or ratio is determined from the amplitude or phase or frequency differences calculated, and may include components of the underlying amplitude or B-Mode image. Such info can be taken from one or more sets of received echo data.

[0114] The microcalcifications imaging and detection system and methods thereof may include or be configured so the microcalcification identifier uses an estimated difference to distinguish microcalcifications from background. Such determination may be based on, for example, the level or ratio of the difference between signals. For example, the difference at spatial location A=10=>not microcalcification. The difference at spatial location B=1000=>microcalcification. The ratio can be determined between sets of difference data.

[0115] The microcalcifications imaging and detection system and methods thereof may include or be configured so the processor 22 is configured to form an image based on the data, wherein the processor 22 identifies the distinguished microcalcifications on the image. This may be done, for example, based on the level or ratio of the difference between signals. For example, a difference at spatial location A=10=>not microcalcification. Difference at spatial location B=1000=>microcalcification. The ratio can be determined between sets of difference data.

[0116] Microcalcifications imaging and detection system 10 and methods thereof may include or be configured so the processor 22 can output a visual display distinguishing microcalcifications in an ultrasound view. This output can be displayed as a scan converted image alone or overlaid on the B-Mode image as a color overlay, or can be stored as spatial locations in a computer readable format.

[0117] The microcalcifications imaging and detection system and methods thereof may include or be configured so the display unit 16 displays microcalcifications visually distinguished from the background. This may be done by use of a color overlay of the probability a microcalcification exists in a given spatial location. Probability is derived from the difference signals.

[0118] The microcalcifications imaging and detection system 10 and methods thereof may include or be configured so the use of the difference factor determinator is configured to use the data with respect to a plurality of spatial points having, respectively, an associated transmission event and a delay profile or spatial location. This may be performed by taking the difference values between echoes corresponding to the same spatial locations. This can be done at more than one spatial location per data set, including multi line acquisition beamformers, pixel based beamformers, frequency domain beamformers, etc., at multiple receive depths/delays, lateral locations, etc. The difference factor determinator may be configured to use received data to estimate the difference separately by point with respect to the plurality of points.

[0119] The microcalcifications imaging and detection system and methods thereof may include or be configured so the microcalcification identifier is configured to combine estimates of the magnitude difference of each point to identify microcalcifications. Such action may be accomplished by summing or averaging the estimates of the difference at each point. The microcalcification classifier may be configured to use thresholding to distinguish the microcalcifications from the background.

[0120] The microcalcifications imaging and detection system and methods thereof may include or be configured so the microcalcification determinator estimates probability of a microcalcification by summing, over multiple transmit packets, a function of the data with respect to a given receive acoustic line and a given time or spatial depth. Such action may also be performed by summing the function over the channels independently.

[0121] The microcalcifications imaging and detection system and methods thereof may include or be configured so that data obtained comprises radiofrequency, demodulated, beamformed or channel data, and the difference determinator derives the magnitude from one or more transmission events or from the differences in the composite frequencies (fundamental and harmonics, chirp components etc).

[0122] FIGS. 2A-2C provide illustrative embodiments of the visualizing microcalcifications. One or more transmit elements insonify an area of tissue with one or more cycles of acoustic compression and rare fraction (transmit packet). The sound waves interact with the tissue, compressing and stretching it based on the material properties of the tissue. When there is an abrupt change in the acoustic material properties that make up the acoustic impedance, such as a microcalcification embedded in tissue, the tissue and microcalcification will react differently to the acoustic wave, inducing a slight damped harmonic oscillation between the two. This effect can be magnified by increasing the length of the transmit packet by sending multiple compression and rare fraction cycles into the tissue. For example, a sine wave extending over 8 cycles (++++ or ++++ or +0+0+0+0 or 0000 etc.) will have a better signal to noise ratio than a single cycle pulse (+ or +) or half cycle pulse (+ or ). The effect can also be observed and/or magnified with coded transmissions, such as (but not limited to) Golay or Barker codes, chirps, pulse inversion techniques, multi-frequency transmissions, sub-aperture variations in the transmit pattern (frequency, phase, power, pulse pattern, etc.) for multi element arrays, acoustic power variations, such as changing the applied transmit voltage, current drive, jitter, pulse pattern, aperture size, etc.

[0123] The difference operation can be made in many ways, though the simplest is a direct subtraction between two pairs of received echoes (acoustic lines), RF data with the same transmit receive delays, phase, and spatial location characteristics.

[0124] Similar approaches would include:

[0125] The cross correlation/covariance value between two lines deviating from 1, or 1 in the case of pulse inverted transmissions.

[0126] The amplitude difference between the I1 and I2 or Q1 and Q2 or some other combination of demodulated signals, such as the phase angle (arctan(I1/Q1)arctan(I2/Q2))

[0127] The amplitude or phase difference of frequency domain components of the received signal, e.g. Fourier transform frequency component amplitude or phase variations in the I and Q.

[0128] The signal may also be broken up into return cycles that are compared in a single acoustic line response, e.g., the system transmits an 8 sine wave packet into the tissue and on receive, separates each of the returned cycles in time and compares them with each other based on the expected cycle duration. For example, a 4 MHz sine wave sampled at 40 Mhz would cover 10 samples per cycle for a total of 80 samples at 8 cycles. The subsections of the reflected signal can be compared for phase changes from varying oscillations from one or more acoustic lines.

[0129] In order to differentiate changes in the signal received from blood flow, a threshold may be used to discriminate tissue vs blood. This may comprise an echo amplitude threshold, a variance based threshold, or a difference based on transmit or receive characteristics, e.g. a pulse packet may be focused at a first transmission depth, some distance away from the microcalcification, and then closer to the microcalcification, and then calculating the change in the difference signal extracted. The microcalcifications exhibit a nonlinear response in the difference signal compared to the background tissue which can be discriminated in the difference signal based on the power in the acoustic wave at the point of the microcalcification.

Example 1

[0130] Step 1: Transmit a packet, see step 1000, FIG. 2A,

[0131] Step 2: Capture receive signal corresponding to a spatial location, see step 1002,

[0132] Step 3: Transmit the same packet again, see step 1004,

[0133] Step 4: Capture receive signals corresponding to the same spatial location as in step 2, see step 1006,

[0134] Step 5: Take the difference between the signals from steps 2 and 4, see step 1008,

[0135] Step 6: take the magnitude of the difference signal, see step 1010.

Example 2

[0136] Two transmit packets focused at spatial locations Point 1 and 2, See FIG. 2B, 1012,

[0137] Point 1 is shallow to the microcalcification,

[0138] Point 2 is at or closer to the microcalcification,

[0139] Point 3 is at the microcalcification,

[0140] Step 1: Transmit packet focused at point 1, see step 1014,

[0141] Step 2: Receive echo signals corresponding to reflections from point 3, see step 1016,

[0142] Step 3: Repeat Steps 1 and 2 to have two or more received data points, see step 1018,

[0143] Step 4: Take the difference between the two or more signals, see step 1020,

[0144] Step 5: Transmit packet focused at point 2, see step 1022,

[0145] Step 6: Receive echo signals corresponding to reflections from point 3, see step 1024,

[0146] Step 7: Repeat steps 5 and 6 to have two or more received data points, see step 1026,

[0147] Step 8: Take the difference between the two or more signals, see step 1028,

[0148] Step 9: Compare the difference values calculated from steps 4 and 8, see step 1030.

Example 3

[0149] Step 1: Transmit a packet into the region of interest, see FIG. 2C, step 1032,

[0150] Step 2: Receive echo signals corresponding to each transmitted cycle reflected from the same spatial locations, step 1034,

[0151] Step 3: Take the difference between signals corresponding to the different cycles transmitted, step 1036,

[0152] Taking the difference:

Example 1

[0153] Step 1: Transmit packet A,

[0154] Step 2: Receive signals corresponding to a spatial location,

[0155] Step 3: Repeat steps 1 and 2 four times to capture signals 1, 2, 3, 4 (may be RF, demodulated, frequency domain transformed, etc.),

[0156] Step 4: Subtract the amplitude of the pairs to form difference signals and sum/average the magnitudes,

[0157] abs(1-2)+abs(1-3)+abs(1-4)+abs(2-3)+abs(2-4)+abs(3-4)

Example 2

[0158] Step 1: Transmit packet A,

[0159] Step 2: Receive signals corresponding to a spatial location,

[0160] Step 3: Repeat steps 1 and 2 four times to capture signals 1, 2, 3, 4,

[0161] Step 4: Correlate pairs to form correlation value signals,

[0162] corr(1,2)+corr(1,3)+corr(1,4)+corr(2,3)+corr(2,4)+corr(3,4)

Example 4

[0163] Step 1: Transmit packet A,

[0164] Step 2: Receive signals corresponding to a spatial location,

[0165] Step 3: Separate frequency bands from the signal via filtering, demodulation, or frequency domain techniques,

[0166] Step 4: Compare the amplitude or phase from the different frequency bands from one or more cycles.

Example 5

[0167] Step 1: Transmit packet A,

[0168] Step 2: Receive signals corresponding to a spatial location,

[0169] Step 3: Repeat steps 1+2,

[0170] Step 4: Separate the received data into a fundamental and harmonic frequency component,

[0171] Step 5: Compare the amplitude or phase from the different frequency bands and take the ratio of the differences. FIG. 11C (fundamental) and FIG. 11D (harmonic) show the variation is higher in the harmonic frequencies vs. the fundamental.

[0172] FIG. 1 shows an ultrasound system with a transmit unit (18) capable of delivering a transmit packet into the tissue, and a receive unit (20) capable of capturing returning echo signals from the tissue. The microcalcification detection circuit may be included in the computing system (14) or processor (22) or offloaded to another processing unit (30). The output of the microcalcification detector may be sent to one or more of: the display (16) stored in memory (24) or a database (28), or offloaded to external storage or processor (30).

[0173] FIG. 2A shows one simple embodiment of the technique. 1000 A pulse packet is transmitted into the tissue and the returning signals are captured (1002). This is then repeated one or more times (1004-1006). The received signals are then compared to produce a difference signal (1008). The magnitude of the difference signals are then summed (1010).

[0174] FIG. 2B shows an improved version of the process where different transmit characteristics are employed to alter the signal in a specific way that allows a better discrimination of the microcalcifications. In an ideal embodiment of the process, the system would transmit a pulse packet focused at a first location (1014), receive the echo signals from the insonified area (1016), and repeat this process multiple times (1018), and calculate a difference between then signals (1020). Then transmit a second pulse packet focused at a location spatially different from the first, such as deeper into the tissue (1022), and receive signals corresponding to the same spatial locations as in (1016), (1024) repeat multiple times (1026) and calculate a difference between the second group of signals (1028). These transmit receive events (focal points) may be interleaved in time to reduce temporal artifacts. The pulse packet variation may be from altering the focus point (FIG. 17) or other characteristics of the transmit packet such as voltage (FIG. 16), aperture size, waveform, etc. The difference between the difference signals (1020, 1028) are then compared to reduce artifacts from moving blood or blood vessels, and discriminate microcalcifications (1030).

[0175] It is possible to distinguish microcalcifications based on a single transmit packet and receive event, by comparing variations between cycles in the pulse packet or between frequency components of the signal, see FIG. 2C.

[0176] Referring to FIG. 3, an acoustic line 100 of an agar phantom filled with corn starch to provide backscatter with both 4 cycle inverted and non-inverted packets is shown. The initial pulse's acoustic line of digitizations 101 and the inverted pulse's acoustic line of digitizations 103 are shown. The agar phan tom is a homogeneous medium and presents no phase aberration that would be caused in a patient by the different speeds of sound of the fat and tissues between the transducer and the reflectors, and so presents as synchronous sine waves. Phase aberration can be minimized by known ultrasonic techniques when required. The numbers on the center axis line are the individual digitations which throughout this document are made at 40 MHz or every 25 nanoseconds.

[0177] FIG. 4 illustrates an acoustic line of an agar phantom filled with corn starch to provide backscatter with a microcalcification. As shown in the figure, eight acoustic lines first pass through agar with corn starch (to create backscatter) and a microcalcification of calcium Hydroxyapatite, 150-microns diameter. On the left, 102, in simulated soft tissue, the eight lines, align nearly perfectly. Towards the right, 104, the microcalcification is encountered and the lines break apart due to chaotic oscillations between the microcalcification and the background tissue.

[0178] FIG. 5 illustrates a magnified view of acoustic lines 106, each of a different color, at the point of the microcalcification, which is shown occurring at the 100th digitation. Reference ID number 107 indicates the digitization indicator and 109 shows the separation of the eight acoustic lines at the zero crossing point at digitization 100. From the fact that the acoustic lines 106 are spread over approximately one quarter of the digitization rate, it can be inferred that the lines separate by just less than 4-nanoseconds, which at 1540 meters per second (speed of sound in water), is implying a movement of approximately 3-microns.

[0179] FIG. 6 shows a B-Mode Image fused with a CA-Mode Image 108 of a piece of fat 113 embedded in a gelatin phantom 111. A B-Mode Image is a greyscale image of the morphology in the lexicon of medical ultrasound. A new CA-Mode Image 115 provides the imaging of the aberrations that occur at the microcalcifications. The CA-Mode shows only the microcalcifications, but a small pinkish hint can be seen at some interfaces in the muscle. These pinkish flecks will be removed in the final CA-Mode by a threshold such as outlined in FIG. 2B.

[0180] FIG. 7A shows the digitization of 8 acoustic lines at the microcalcification 117 and at the boundary layer 110. FIG. 7B illustrates subtraction of pairs of acoustic lines. FIG. 7A shows, just visible, the breakup of the acoustic lines at the microcalcification 117. This image is the digitizations used to form one acoustic line shown in FIG. 8, which illustrates the microcalcification and boundary layer in B-Mode. FIG. 7B illustrates a graph showing the subtraction of pairs of acoustic lines 112 at the same depth. The FIG. 7B graph (subtraction) yields maximum value of 2000 at the microcalcification 114, and maximum value of approximately 200 121 at the boundary layer, which is a signal to noise value of ten, so a threshold of 250 would provide a noise free microcalcification image.

[0181] FIG. 8 shows a magnified B-Mode Image 116 fused with a CA-Mode Image 125 of a microcalcification 123 in front of a boundary layer 127. Note that the only place the CA-Mode shows signal is on the microcalcification.

[0182] FIG. 9 illustrates a piece of pork 118 with microcalcifications placed in a cut 120 in a beaker held by gelatin. This piece of pork contains fat and muscle, and many like it have been used to create images and data.

[0183] FIGS. 10A-10E illustrate the stages of the interaction of the multiple super imposed transmit pulse packet events and the microcalcification. FIG. 10A shows the incoming transmit pulse packet (122) and the undisturbed (not oscillating, vibrating, or moving in random directions) microcalcification (124). FIG. 10B shows the first pulses of the incoming transmit pulse packet disturbing the microcalcification (126). FIG. 10C shows the buildup in vibration of the microcalcification and its effects on the reflected waves (128). FIG. 10D shows further escalation of the effects of more transmit pulses interacting with the microparticle and the buildup in effects on the reflected wave (130). FIG. 10E shows the reduced energy transmit wave (132) proceeding deeper into the patient and the disturbed echo pulse packet (134) returning to the transducer.

[0184] FIG. 11A and FIG. 11B show the effects of the counter-propagating waves proximal to the microcalcification at the extremes. The echo depicted as the dotted line will be launched from a plurality of positions of the microcalcification. In FIG. 11A the echo (136) is completely out of phase with the incoming Transmit Pulse Packet and will reduce the amplitude (140) of the pulse and its effects on the microcalcification. In FIG. 11B the echo (142) is more in phase with the incoming Transmit Pulse Packet and will enhance the amplitude (144) of the pulse and its effects on the microcalcification. Obviously, a microcalcification vibrating at a frequency above the pulse frequency will cause a multiple of reflections during the transit of the Transmit Pulse Packet, inducing a multitude of overlapping echoes which can be described as chaos or higher frequencies or differences in the times of flights.

[0185] FIG. 12 is a description of the processes in pulse inversion harmonic imaging. The process of pulse inversion is well known in the art, and is useful for removing the fundamental transmit frequency from the signal to be analyzed. The process begins by transmitting a pulse packet (146), which the transducer, due to its limited bandwidth, will convert into approximately sine waves (150), which, after travelling through tissue which will travel faster in the compressions and slower in the rarefactions (152), will develop harmonics, (predominantly the second harmonic) (154) and the acoustic line will be recorded. The next transmit packet will be inverted from the first (148) and the same natural processes will occur. The two acoustic lines will be added (156) and the harmonic components will add together and the fundamental will cancel, leaving mostly just the even harmonic signals (158).

[0186] FIG. 13A shows eight different RF acoustic lines showing the signal from a microcalcification on the left, 160, followed by a boundary layer of greater acoustic reflective power (right) 162. The box in FIG. 13A shows a magnified view 131 from the trailing right edge of the microcalcification and illustrates the chaos at the valley 133. FIG. 13B illustrates color-coded subtraction results 164 of the eight acoustic lines (line 1line 2, line 2line 3, line 3line 4, line 4line 5, line 5line 6, line 6line 7, and line 7line 8) shown in FIG. 13A at the same location in the acoustic lines. At the microcalcification there is a strong signal which is dependent on the power of the insonification at the microcalcification, and in this instance these results have a numerical value of 2,000 to 30,000. The subtracted lines show a very small signal at the originally larger backscatter position 135 of the boundary layer, which in this instance typically has a numerical value of 20 to 200. The background signal where there is no signal in FIG. 13A is shown as very low in the subtractions in FIG. 13B 137. FIG. 13C illustrates an expanded section of the demodulated and filtered fundamental 166 for the acoustic lines gathered for FIG. 13A at the microcalcification 139 and at the boundary 141.

[0187] FIG. 13C is the demodulated and filtered fundamental signals from FIG. 13A. FIG. 13D is the demodulated and filtered harmonic signal from FIG. 13A. The variations at the microcalcification 143 and the boundary 145 in the Harmonic signal are higher than those in the fundamental, though both are present.

[0188] FIG. 13D is the demodulated and filtered second harmonic 168 from the acoustic lines gathered for FIG. 13A at the microcalcification. The ratio of the magnitudes of the fundamental to the second harmonic is found to be indicative of the spherical microcalcifications anisotropic backscatter priority of energy reflected back to the transducer.

[0189] FIG. 14 illustrates an image from which the acoustic line was selected for FIGS. 13 A,B,C and D. FIG. 14 is of a agar phantom with a light doping of corn starch in the top 171 and a heavier doping of corn starch in the bottom 175 creating a boundary 173 shown the B-Mode in grayscale and the CA-Mode 170 in red, which is visible only at the microcalcification in the agar phantom.

[0190] FIG. 15 is a description of the non-inotropic backscatter from a particle approximately the same size as the incident wavelength of the insonification. As the fundamental has a longer wavelength than the particle size (for example, at 4 MHz the wavelength is 375 microns and the target microcalcification is 150 microns, the match is not good. The second harmonic has a wavelength of 187 microns, which is a much nearer match and the priority of the non-inotropic nature of the backscatter is clearly seen in the amplitude shown in FIG. 11C and FIG. 11D. The varying aperture made from the selection of elements shown in FIG. 13 can also be used to quantitatively assess this non-isotropic nature. The non-isotropic nature of the reflection may also be attributed to the density of the particle vs the background.

[0191] FIG. 16 illustrates four sets of eight transmit packets and received acoustic lines with the same characteristics such as phase, delay, freq, focal point, etc, but with an increasing voltage applied to the transmit packet, from 50 to 80V. The microcalcification (184) responds with significantly more chaotic oscillations with a higher transmit packet power as seen in the difference magnitude (188 vs 190) than normal tissue structures or interfaces (186).

[0192] FIG. 17 Shows 3 sets of 8 transmit packets and received acoustic lines with the same voltage but focused at different depths (12 mm, 15 mm, 20 mm) where the microcalcification is centered at a depth of about 16 mm (192) with a defined border behind it (194). The change in the power of the transmit packet at the location of the microcalcification (192) from changing the transmit focal location shows a difference in the response of the microcalcification to the change in the amplitude of the transmit packet power at the microcalcification. Compared to the border (194) where there is little change in the difference signals (196, 198).

[0193] All patents and publications mentioned in this specification are indicative of the levels of those skilled in the art to which the invention pertains. All patents and publications are herein incorporated by reference to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference.

[0194] It is to be understood that while a certain form of the invention is illustrated, it is not to be limited to the specific form or arrangement herein described and shown. It will be apparent to those skilled in the art that various changes may be made without departing from the scope of the invention and the invention is not to be considered limited to what is shown and described in the specification and any drawings/figures included herein.

[0195] One skilled in the art will readily appreciate that the present invention is well adapted to carry out the objectives and obtain the ends and advantages mentioned, as well as those inherent therein. The embodiments, methods, procedures and techniques described herein are presently representative of the preferred embodiments, are intended to be exemplary, and are not intended as limitations on the scope. Changes therein and other uses will occur to those skilled in the art which are encompassed within the spirit of the invention and are defined by the scope of the appended claims. Although the invention has been described in connection with specific preferred embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes for carrying out the invention which are obvious to those skilled in the art are intended to be within the scope of the following claims.