Development of a freehand three-dimensional radial endoscopic ultrasonography system
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Oesophageal cancer is an aggressive malignancy with an overall five-year survival of 5-10% and two-thirds of patients have irresectable disease at diagnosis. Accurate staging of oesophageal cancer is important as survival closely correlates with the stage of the tumour, nodal involvement and presence of metastases (TNM staging). Endoscopic ultrasonography (EUS) is currently the most reliable modality for providing accurate T and N staging. Depending on findings of the staging, various treatment options including endoscopic, oncological, and surgical treatments may be performed. It was theorised that the development of three-dimensional radial endoscopic ultrasonography would reduce the operator dependence of EUS and provide accurate dimensional and volume measurements to aid planning and monitoring of treatment. This thesis investigates the development of a three dimensional endoscopic ultrasound technique that can be used with the radial echoendoscopes. Various agar-based tissue mimicking material (TMM) recipes were characterised using a scanning acoustic macroscope to obtain the acoustic properties of attenuation, backscatter and speed of sound. Using these results, a number of endoscopic ultrasound phantoms were developed for the in-vitro investigation and evaluation of 3D-EUS techniques. To increase my understanding of EUS equipment, the imaging and acoustic properties of the EUS endoscopes were characterised using a pipe phantom and a hydrophone. The dual ‘single element’ mechanical and ‘multi-element’ electronic echoendoscopes were investigated. Measured imaging properties included dead space, low contrast penetration, and pipe length. The measured acoustic properties included transmitted beam plots, active working frequency and peak pressures. Three-dimensional ultrasound techniques were developed for specific application to EUS. This included the study of positional monitoring systems, reconstruction algorithms and measurement techniques. A 3D-EUS system was developed using a Microscribe positional arm and frame grabber card, to acquire the 3D dataset. A Matlab 3D-EUS toolbox was written to reconstruct and analyse the volumes. The 3D-EUS systems were evaluated on the EUS phantom and in clinical cases. The usefulness of the 3D-EUS systems was evaluated in a cohort of patients, who were routinely investigated by conventional EUS for a variety of upper gastrointestinal pathology. 3D-EUS accurately staged early tumours and provided the necessary anatomical information to facilitate treatment. With regards to more advanced tumours, 3D-EUS was more accurate than EUS in T and N staging. 3D-EUS gave useful anatomical details in a variety of benign conditions such as varicies and GISTs.