In radiology practices, the ultrasound-guided breast biopsy is among the most commonly performed minimally invasive procedures. However, many radiology residents in their graduate residencies are found with little or no hands-on experience with ultrasound-guided breast procedures. To enhance safety, the problem can be solved by using anthropomorphic training phantoms which provide the resident with realistic ultrasound imaging and needle insertion haptic feedback. Stiffness and acoustic properties of breast tissues vary between individuals. The training breast phantom should be able to possess different acoustic and mechanical properties which conform the inconsistencies found in real tissues among people. Therefore, this study is to develop a more realistic and attainable biopsy training phantom for all types of breast needle biopsy which requires precise insertion.
The thesis is divided into two parts: I) low-cost and easy to fabricate gelatin-based phantom; II) a more realistic breast tissue mimicking phantom in ultrasound imaging and needle insertion haptic feedback. In part I, the developed gelatin-based phantom was embedded with a simulated malignant tumor, two benign tumors, and a cyst. The proposed phantom could be easily fabricated by resident himself for breast biopsy training. Young’s modulus and acoustic properties (speed of sound, attenuation coefficient, and relative backscattering) for the gelatin tissue phantom and simulated tumors were studied. The effectiveness of the developed phantom in improving the biopsy skill level of residents was evaluated. It was found that the participants’ subjective confidence levels in performing challenging ultrasound-guided breast biopsy procedures substantially increased with the use of phantom simulation training. Therefore, our phantom is realistic enough such that the training outcome can be linked to the performance of the residents when they perform a biopsy on patients. While in part II, the tunability of acoustic and mechanical behaviors in breast tissue mimicking materials were investigated. A comprehensive study was carried out in an attempt to understand the effect of the component’s concentration on acoustic properties of breast tissue mimicking materials. The speed of sound and attenuation coefficient for real breast tissues that found in literature were targeted outcome. Experiments of central composite design with a center point, four corner points, and an additional four axis points were used to fit the non-linear regression model of the speed of sound. The same design of experiment approach was then used to fit the second-order response surface of the attenuation coefficient. Tissue mimicking materials which possessed acoustic properties that closed to real glandular tissue and malignant lesion were suggested. Next, the Latin hypercube design method was conducted to evaluate the main factors that affected the mechanical property (Young’s modulus) of tissue mimicking materials. Based on doctor feedback, suggested tissue mimicking materials were then tweaked to produce Young’s modulus which was similar to human fat tissue, glandular tissue, benign tumor, and malignant tumor. Furthermore, to develop a breast phantom with realistic ultrasound imaging, the relative backscatter power of tissue mimicking materials was then further studied to adjust the contrast of embedded tumor to the background glandular tissue. The experiment of central composite design with a center point and four corner points were used to study the effect of concentration of aluminum oxide and silicon carbide on the relative backscatter power of glandular tissue sample. Meanwhile, the Latin hypercube design method was used to investigate the main factors that affected the relative backscatter power of tumor tissue sample. The results showed that the recipe of tissue mimicking materials could be customized to possess different acoustic and mechanical properties which conform the inconsistencies found in real breast tissues.

[1] Stewart, B., and Wild, C. P. World cancer report 2014. 2014.
[2] O'Flynn, E. A., Wilson, A. R., and Michell, M. J. Image-guided breast biopsy: state-of-the-art. Clin Radiol 65:259-270. 2010.
[3] Maxwell, A. J., Ridley, N. T., Rubin, G., Wallis, M. G., Gilbert, F. J., Michell, M. J., and Royal College of Radiologists Breast, G. The Royal College of Radiologists Breast Group breast imaging classification. Clin Radiol 64:624-627. 2009.
[4] American College of Radiology. Illustrated breast imaging reporting and data system (BI-RADS). American College of Radiology 2003.
[5] Cox, T. R., and Erler, J. T. Remodeling and homeostasis of the extracellular matrix: implications for fibrotic diseases and cancer. Dis Model Mech 4:165-178. 2011.
[6] Samani, A., Zubovits, J., and Plewes, D. Elastic moduli of normal and pathological human breast tissues: an inversion-technique-based investigation of 169 samples. Phys Med Biol 52:1565-1576. 2007.
[7] Unlu, M. Z., Krol, A., Magri, A., Mandel, J. A., Lee, W., Baum, K. G., Lipson, E. D., Coman, I. L., and Feiglin, D. H. Computerized method for nonrigid MR-to-PET breast-image registration. Comput Biol Med 40:37-53. 2010.
[8] Wellman, P., Howe, R. D., Dalton, E., and Kern, K. A. J. H. B. L. T. R. Breast tissue stiffness in compression is correlated to histological diagnosis.1-15. 1999.
[9] Krouskop, T. A., Wheeler, T. M., Kallel, F., Garra, B. S., and Hall, T. Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging 20:260-274. 1998.
[10] Jurvelin, J. S., Buschmann, M. D., and Hunziker, E. B. Optical and mechanical determination of Poisson's ratio of adult bovine humeral articular cartilage. J Biomech 30:235-241. 1997.
[11] Barr, R. G., and Zhang, Z. Effects of precompression on elasticity imaging of the breast: development of a clinically useful semiquantitative method of precompression assessment. J Ultrasound Med 31:895-902. 2012.
[12] Ramiao, N. G., Martins, P. S., Rynkevic, R., Fernandes, A. A., Barroso, M., and Santos, D. C. Biomechanical properties of breast tissue, a state-of-the-art review. Biomech Model Mechanobiol 15:1307-1323. 2016.
[13] Collins, D. E. Tissue substitutes, phantoms, and computational modelling in medical ultrasound. International Commission on Radiation Units and Measurements, Bethesda, Md. 1998.
[14] John, C. The corono-apically varying ultrasonic velocity in human hard dental tissues. J Acoust Soc Am 116:545-556. 2004.
[15] Philibert, I. Simulation and rehearsal. ACGME Bulletin. Accreditation Council for Graduate Medical Education website. 2005.
[16] Silver, B., Metzger, T. S., and Matalon, T. A. A simple phantom for learning needle placement for sonographically guided biopsy. AJR Am J Roentgenol 154:847-848. 1990.
[17] Sutcliffe, J., Hardman, R. L., Dornbluth, N. C., and Kist, K. A. A novel technique for teaching challenging ultrasound-guided breast procedures to radiology residents. J Ultrasound Med 32:1845-1854. 2013.
[18] Bude, R. O., and Adler, R. S. An Easily Made, Low-Cost, Tissue-Like Ultrasound Phantom Material. J Clin Ultrasound 23:271-273. 1995.
[19] Georgian-Smith, D., and Shiels, W. E. From the RSNA refresher courses. Freehand interventional sonography in the breast: basic principles and clinical applications. Radiographics 16:149-161. 1996.
[20] Harvey, J. A., Moran, R. E., Hamer, M. M., DeAngelis, G. A., and Omary, R. A. Evaluation of a turkey-breast phantom for teaching freehand, US-guided core-needle breast biopsy. Acad Radiol 4:565-569. 1997.
[21] Sisney, G. A., and Hunt, K. A. A low-cost gelatin phantom for learning sonographically guided interventional breast radiology techniques. AJR Am J Roentgenol 171:65-66. 1998.
[22] Hassard, M. K., McCurdy, L. I., Williams, J. C., and Downey, D. B. Training module to teach ultrasound-guided breast biopsy skills to residents improves accuracy. Can Assoc Radiol J 54:155-159. 2003.
[23] Morehouse, H., Thaker, H. P., and Persaud, C. Addition of Metamucil to gelatin for a realistic breast biopsy phantom. J Ultrasound Med 26:1123-1126. 2007.
[24] Meng, K., and Lipson, J. A. Utilizing a PACS-integrated ultrasound-guided breast biopsy simulation exercise to reinforce the ACR practice guideline for ultrasound-guided percutaneous breast interventional procedures during radiology residency. Acad Radiol 18:1324-1328. 2011.
[25] Nicholson, R. A., and Crofton, M. Training phantom for ultrasound guided biopsy. Br J Radiol 70:192-194. 1997.
[26] Ruschin, M., Davidson, S. R., Phounsy, W., Yoo, T. S., Chin, L., Pignol, J. P., Ravi, A., and McCann, C. Technical Note: Multipurpose CT, ultrasound, and MRI breast phantom for use in radiotherapy and minimally invasive interventions. Med Phys 43:2508. 2016.
[27] Vieira, S. L., Pavan, T. Z., Junior, J. E., and Carneiro, A. A. Paraffin-gel tissue-mimicking material for ultrasound-guided needle biopsy phantom. Ultrasound Med Biol 39:2477-2484. 2013.
[28] Smith, W. L., Surry, K. J., Kumar, A., McCurdy, L., Downey, D. B., and Fenster, A. Comparison of core needle breast biopsy techniques: freehand versus three-dimensional US guidance. Acad Radiol 9:541-550. 2002.
[29] Madsen, E. L., Zagzebski, J. A., and Frank, G. R. An anthropomorphic ultrasound breast phantom containing intermediate-sized scatteres. Ultrasound in Medicine & Biology 8:381-392. 1982.
[30] Madsen, E. L., Hobson, M. A., Frank, G. R., Shi, H., Jiang, J., Hall, T. J., Varghese, T., Doyley, M. M., and Weaver, J. B. Anthropomorphic breast phantoms for testing elastography systems. Ultrasound Med Biol 32:857-874. 2006.
[31] Shaw, A., and Rob Hekkenberg. Standards to support performance evaluation for diagnostic ultrasound imaging equipment. National Physical Laboratory. 2007.
[32] Cannon, L. M., Fagan, A. J., and Browne, J. E. Novel tissue mimicking materials for high frequency breast ultrasound phantoms. Ultrasound Med Biol 37:122-135. 2011.
[33] Teirlinck, C. J. P. M., Bezemer, R. A., Kollmann, C., Lubbers, J., Hoskins, P. R., Fish, P., Fredfeldt, K. E., and Schaarschmidt, U. G. Development of an example flow test object and comparison of five of these test objects, constructed in various laboratories. Ultrasonics 36:653-660. 1998.
[34] Brewin, M. P., Pike, L. C., Rowland, D. E., and Birch, M. J. The acoustic properties, centered on 20 MHZ, of an IEC agar-based tissue-mimicking material and its temperature, frequency and age dependence. Ultrasound Med Biol 34:1292-1306. 2008.
[35] Scherzinger, A. L., Belgam, R. A., Carson, P. L., Meyer, C. R., Sutherland, J. V., Bookstein, F. L., and Silver, T. M. Assessment of ultrasonic computed tomography in symptomatic breast patients by discriminant analysis. Ultrasound Med Biol 15:21-28. 1989.
[36] D'Astous, F. T., and Foster, F. S. Frequency dependence of ultrasound attenuation and backscatter in breast tissue. Ultrasound Med Biol 12:795-808. 1986.
[37] Zhang, M., Zheng, Y. P., and Mak, A. F. T. Estimating the effective Young's modulus of soft tissues from indentation tests—nonlinear finite element analysis of effects of friction and large deformation. Medical Engineering & Physics 19:512-517. 1997.
[38] Shung, K. K. Diagnostic ultrasound: Imaging and blood flow measurements. 2005.
[39] AIUM Committee. Methods for specifying acoustic properties of tissue mimicking phantoms and objects. Laurel, MD: American Institute of Ultrasound in Medicine. 1995.
[40] Welch, P. The use of fast Fourier transform for the estimation of power spectra: A method based on time averaging over short, modified periodograms. IEEE Transactions on Audio and Electroacoustics 15:70-73. 1967.
[41] Stavros, A. T., Thickman, D., Rapp, C. L., Dennis, M. A., Parker, S. H., and Sisney, G. A. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology 196:123-134. 1995.
[42] Burnside, E. S., Hall, T. J., Sommer, A. M., Hesley, G. K., Sisney, G. A., Svensson, W. E., Fine, J. P., Jiang, J., and Hangiandreou, N. J. Differentiating benign from malignant solid breast masses with US strain imaging. Radiology 245:401-410. 2007.
[43] Wear, K. A., Stiles, T. A., Frank, G. R., Madsen, E. L., Cheng, F., Feleppa, E. J., Hall, C. S., Kim, B. S., Lee, P., O'Brien, W. D., Jr., Oelze, M. L., Raju, B. I., Shung, K. K., Wilson, T. A., and Yuan, J. R. Interlaboratory comparison of ultrasonic backscatter coefficient measurements from 2 to 9 MHz. J Ultrasound Med 24:1235-1250. 2005.