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Marlevi, D., Ruijsink, B., Balmus, M., Dillon-Murphy, D., Fovargue, D., Pushparajah, K., . . . Nordsletten, D. A. (2019). Estimation of Cardiovascular Relative Pressure Using Virtual Work-Energy. Scientific Reports, 9(1), Article ID 1375.
Open this publication in new window or tab >>Estimation of Cardiovascular Relative Pressure Using Virtual Work-Energy
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, no 1, article id 1375Article in journal (Refereed) Published
Abstract [en]

Many cardiovascular diseases lead to local increases in relative pressure, reflecting the higher costs of driving blood flow. The utility of this biomarker for stratifying the severity of disease has thus driven the development of methods to measure these relative pressures. While intravascular catheterisation remains the most direct measure, its invasiveness limits clinical application in many instances. Non-invasive Doppler ultrasound estimates have partially addressed this gap; however only provide relative pressure estimates for a range of constricted cardiovascular conditions. Here we introduce a non-invasive method that enables arbitrary interrogation of relative pressures throughout an imaged vascular structure, leveraging modern phase contrast magnetic resonance imaging, the virtual work-energy equations, and a virtual field to provide robust and accurate estimates. The versatility and accuracy of the method is verified in a set of complex patient-specific cardiovascular models, where relative pressures into previously inaccessible flow regions are assessed. The method is further validated within a cohort of congenital heart disease patients, providing a novel tool for probing relative pressures in-vivo.

Place, publisher, year, edition, pages
Nature Publishing Group, 2019
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:kth:diva-246401 (URN)10.1038/s41598-018-37714-0 (DOI)000457616300263 ()30718699 (PubMedID)2-s2.0-85061047544 (Scopus ID)
Note

QC 20190321

Available from: 2019-03-21 Created: 2019-03-21 Last updated: 2019-08-21Bibliographically approved
Smoljkić, M., Verbrugghe, P., Larsson, M., Widman, E., Fehervary, H., D'hooge, J., . . . Famaey, N. (2018). Comparison of in vivo vs. ex situ obtained material properties of sheep common carotid artery. Medical Engineering and Physics, 55, 16-24
Open this publication in new window or tab >>Comparison of in vivo vs. ex situ obtained material properties of sheep common carotid artery
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2018 (English)In: Medical Engineering and Physics, ISSN 1350-4533, E-ISSN 1873-4030, Vol. 55, p. 16-24Article in journal (Refereed) Published
Abstract [en]

Patient-specific biomechanical modelling can improve preoperative surgical planning. This requires patient-specific geometry as well as patient-specific material properties as input. The latter are, however, still quite challenging to estimate in vivo. This study focuses on the estimation of the mechanical properties of the arterial wall. Firstly, in vivo pressure, diameter and thickness of the arterial wall were acquired for sheep common carotid arteries. Next, the animals were sacrificed and the tissue was stored for mechanical testing. Planar biaxial tests were performed to obtain experimental stress-stretch curves. Finally, parameters for the hyperelastic Mooney–Rivlin and Gasser–Ogden–Holzapfel (GOH) material model were estimated based on the in vivo obtained pressure-diameter data as well as on the ex situ experimental stress-stretch curves. Both material models were able to capture the in vivo behaviour of the tissue. However, in the ex situ case only the GOH model provided satisfactory results. When comparing different fitting approaches, in vivo vs. ex situ, each of them showed its own advantages and disadvantages. The in vivo approach estimates the properties of the tissue in its physiological state while the ex situ approach allows to apply different loadings to properly capture the anisotropy of the tissue. Both of them could be further enhanced by improving the estimation of the stress-free state, i.e. by adding residual circumferential stresses in vivo and by accounting for the flattening effect of the tested samples ex vivo.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Common carotid artery, Constitutive modelling, Material properties, Parameter estimation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-227579 (URN)10.1016/j.medengphy.2018.03.006 (DOI)000436635600003 ()2-s2.0-85044339134 (Scopus ID)
Note

QC 20180516

Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-07-16Bibliographically approved
Nordenfur, T., Babic, A., Bulatovic, I., Giesecke, A., Günyeli, E., Ripsweden, J., . . . Larsson, M. (2018). Method comparison for cardiac image registration of coronary computed tomography angiography and 3-D echocardiography. Journal of Medical Imaging, 5(1), Article ID 014001.
Open this publication in new window or tab >>Method comparison for cardiac image registration of coronary computed tomography angiography and 3-D echocardiography
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2018 (English)In: Journal of Medical Imaging, ISSN 2329-4302, E-ISSN 2329-4310, Vol. 5, no 1, article id 014001Article in journal (Refereed) Published
Abstract [en]

Treatment decision for coronary artery disease (CAD) is based on both morphological and functional information. Image fusion of coronary computed tomography angiography (CCTA) and three-dimensional echocardiography (3DE) could combine morphology and function into a single image to facilitate diagnosis. Three semiautomatic feature-based methods for CCTA/3DE registration were implemented and applied on CAD patients. Methods were verified and compared using landmarks manually identified by a cardiologist. All methods were found feasible for CCTA/3DE fusion.

Place, publisher, year, edition, pages
SPIE - International Society for Optical Engineering, 2018
Keywords
coronary artery disease, coronary computed tomography angiography, Image registration, myocardial strain, three-dimensional echocardiography
National Category
Medical Image Processing
Identifiers
urn:nbn:se:kth:diva-221697 (URN)10.1117/1.JMI.5.1.014001 (DOI)000429258000032 ()29322069 (PubMedID)2-s2.0-85040456297 (Scopus ID)
Funder
Swedish Research Council, 2015-04237Stockholm County Council
Note

QC 20180122

Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2018-05-17Bibliographically approved
Marlevi, D., Maksuti, E., Urban, M. W., Winter, R. & Larsson, M. (2018). Plaque characterization using shear wave elastography-evaluation of differentiability and accuracy using a combined ex vivo and in vitro setup. Physics in Medicine and Biology, 63(23), Article ID 235008.
Open this publication in new window or tab >>Plaque characterization using shear wave elastography-evaluation of differentiability and accuracy using a combined ex vivo and in vitro setup
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2018 (English)In: Physics in Medicine and Biology, ISSN 0031-9155, E-ISSN 1361-6560, Vol. 63, no 23, article id 235008Article in journal (Refereed) Published
Abstract [en]

Ultrasound elastography has shown potential for improved plaque risk stratification. However, no clear consensus exists on what output metric to use, or what imaging parameters would render optimal plaque differentiation. For this reason we developed a combined ex vivo and in vitro setup, in which the ability to differentiate phantom plaques of varying stiffness was evaluated as a function of plaque geometry, push location, imaging plane, and analysed wave speed metric. The results indicate that group velocity or phase velocity >= 1 kHz showed the highest ability to significantly differentiate plaques of different stiffness, successfully classifying a majority of the 24 analysed plaque geometries, respectively. The ability to differentiate plaques was also better in the longitudinal views than in the transverse view. Group velocity as well as phase velocities <1 kHz showed a systematic underestimation of plaque stiffness, stemming from the confined plaque geometries, however, despite this group velocity analysis showed lowest deviation in estimated plaque stiffness (0.1 m s(-1) compared to 0.2 m s(-1) for phase velocity analysis). SWE results were also invariant to SWE push location, albeit apparent differences in signal-to-noise ratio (SNR) and generated plaque particle velocity. With that, the study has reinforced the potential of SWE for successful plaque differentiation; however the results also highlight the importance of choosing optimal imaging settings and using an appropriate wave speed metric when attempting to differentiate different plaque groups.

Place, publisher, year, edition, pages
IOP PUBLISHING LTD, 2018
Keywords
shear wave elastography, elastography, ultrasound, atherosclerosis, plaque characterization
National Category
Medical Biotechnology
Identifiers
urn:nbn:se:kth:diva-239984 (URN)10.1088/1361-6560/aaec2b (DOI)000451049000003 ()30468683 (PubMedID)2-s2.0-85057084601 (Scopus ID)
Note

QC 20181211

Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2019-08-21Bibliographically approved
Maksuti, E., Bini, F., Fiorentini, S., Blasi, G., Urban, M. W., Marinozzi, F. & Larsson, M. (2017). Influence of wall thickness and diameter on arterial shear wave elastography: a phantom and finite element study.. Physics in Medicine and Biology, 62(7), 2694-2718
Open this publication in new window or tab >>Influence of wall thickness and diameter on arterial shear wave elastography: a phantom and finite element study.
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2017 (English)In: Physics in Medicine and Biology, ISSN 0031-9155, E-ISSN 1361-6560, Vol. 62, no 7, p. 2694-2718Article in journal (Refereed) Published
Abstract [en]

Quantitative, non-invasive and local measurements of arterial mechanical properties could be highly beneficial for early diagnosis of cardiovascular disease and follow up of treatment. Arterial shear wave elastography (SWE) and wave velocity dispersion analysis have previously been applied to measure arterial stiffness. Arterial wall thickness (h) and inner diameter (D) vary with age and pathology and may influence the shear wave propagation. Nevertheless, the effect of arterial geometry in SWE has not yet been systematically investigated. In this study the influence of geometry on the estimated mechanical properties of plates (h  =  0.5-3 mm) and hollow cylinders (h  =  1, 2 and 3 mm, D  =  6 mm) was assessed by experiments in phantoms and by finite element method simulations. In addition, simulations in hollow cylinders with wall thickness difficult to achieve in phantoms were performed (h  =  0.5-1.3 mm, D  =  5-8 mm). The phase velocity curves obtained from experiments and simulations were compared in the frequency range 200-1000 Hz and showed good agreement (R (2)  =  0.80  ±  0.07 for plates and R (2)  =  0.82  ±  0.04 for hollow cylinders). Wall thickness had a larger effect than diameter on the dispersion curves, which did not have major effects above 400 Hz. An underestimation of 0.1-0.2 mm in wall thickness introduces an error 4-9 kPa in hollow cylinders with shear modulus of 21-26 kPa. Therefore, wall thickness should correctly be measured in arterial SWE applications for accurate mechanical properties estimation.

Place, publisher, year, edition, pages
Institute of Physics (IOP), 2017
National Category
Engineering and Technology
Identifiers
urn:nbn:se:kth:diva-205227 (URN)10.1088/1361-6560/aa591d (DOI)000425859000004 ()28081009 (PubMedID)2-s2.0-85015751378 (Scopus ID)
Note

QC 20170419

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-03-09Bibliographically approved
Larsson, D., Spühler, J. H., Petersson, S., Nordenfur, T., Colarieti-Tosti, M., Hoffman, J., . . . Larsson, M. (2017). Patient-Specific Left Ventricular Flow Simulations From Transthoracic Echocardiography: Robustness Evaluation and Validation Against Ultrasound Doppler and Magnetic Resonance Imaging. IEEE Transactions on Medical Imaging, 36(11), 2261-2275
Open this publication in new window or tab >>Patient-Specific Left Ventricular Flow Simulations From Transthoracic Echocardiography: Robustness Evaluation and Validation Against Ultrasound Doppler and Magnetic Resonance Imaging
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2017 (English)In: IEEE Transactions on Medical Imaging, ISSN 0278-0062, E-ISSN 1558-254X, Vol. 36, no 11, p. 2261-2275Article in journal (Refereed) Published
Abstract [en]

The combination of medical imaging with computational fluid dynamics (CFD) has enabled the study of 3D blood flow on a patient-specificlevel. However, with models based on gated high-resolution data, the study of transient flows, and any model implementation into routine cardiac care, is challenging. The present paper presents a novel pathway for patient-specific CFD modelling of the left ventricle (LV), using 4D transthoracic echocardiography (TTE) as input modality. To evaluate the clinical usability, two sub-studies were performed. First, a robustness evaluation was performed where repeated models with alternating input variables were generated for 6 subjects and changes in simulated output quantified. Second, a validation study was carried out where the pathway accuracy was evaluated against pulsed-wave Doppler (100 subjects), and 2D through-plane phase-contrast magnetic resonance imaging measurements over 7 intraventricular planes (6 subjects). The robustness evaluation indicated a model deviation of <12%, with highest regional and temporal deviations at apical segments and at peak systole, respectively. The validation study showed an error of < 11% (velocities < 10 cm/s) for all subjects, with no significant regional or temporal differences observed. With the patient-specific pathway shown to provide robust output with high accuracy, and with the pathway dependent only on 4DTTE, the method has a high potential to be used within future clinical studies on 3D intraventricular flowpatterns. To this, future model developments in the form of e.g. anatomically accurate LV valves may further enhance the clinical value of the simulations.

Place, publisher, year, edition, pages
Institute of Electrical and Electronics Engineers (IEEE), 2017
National Category
Medical Image Processing
Research subject
Medical Technology
Identifiers
urn:nbn:se:kth:diva-215187 (URN)10.1109/TMI.2017.2718218 (DOI)000414134200007 ()
Funder
Swedish Research Council, 2015-04237Swedish Foundation for Strategic Research , AM13-0049
Note

QC 20171006

Available from: 2017-10-04 Created: 2017-10-04 Last updated: 2017-12-12Bibliographically approved
Maksuti, E., Larsson, D., Urban, M. W., Caidahl, K. & Larsson, M. (2017). Strain and strain rate generated by shear wave elastography in an ex vivo porcine aorta. In: 2017 IEEE International Ultrasonics Symposium (IUS): . Paper presented at 2017 IEEE International Ultrasonics Symposium, IUS 2017, Washington, United States, 6 September 2017 through 9 September 2017. IEEE Computer Society, Article ID 8091581.
Open this publication in new window or tab >>Strain and strain rate generated by shear wave elastography in an ex vivo porcine aorta
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2017 (English)In: 2017 IEEE International Ultrasonics Symposium (IUS), IEEE Computer Society, 2017, article id 8091581Conference paper (Refereed)
Abstract [en]

In order to generate trackable shear waves in soft tissues, transmitted pulses in shear wave elastography (SWE) are longer than conventional clinical ultrasound pulses. Nevertheless, they typically obey mechanical and thermal regulatory limits. In arterial applications, specific safety concerns may arise, as acoustic radiation (ARF)-induced stresses and strain rates could potentially affect the arterial wall. The aim of this study was to assess ARF-induced strain and strain rates in ex vivo arteries. A porcine aorta (diameters 8.5 mm, wall thickness 1.2 mm) was pressurized by a saline-filled water column at 60 and 120 mmHg. A Verasonics V1 system and a L7-4 transducer were used to generate the ARF in the middle of the anterior wall (F-number = 1, push length = [100, 200, 300] μs) and to perform plane-wave imaging (10 kHz). Cumulative axial displacement was estimated using 2D auto-correlation. The axial strain rate was calculated as the time-derivative of the axial strain, obtained by spatial linear regression of the displacement inside the anterior wall. The ex vivo peak strain and strain rate were compared with peak strain and strain rate values induced by the blood pressure changes in two healthy individuals and two patients with coronary artery disease at rest and measured by a dedicated in house speckle tracking algorithm. ARF-induced ex vivo peak strains were in the range 0.3-1% and strain rates in the range 6-23 s-1. Peak values were more affected by longer push duration than pressurization level. In vivo physiological peak strain was 33% and strain rate was 2 s-1. ARF-induced strain rates in vivo are likely to be lower than those assessed in this ex vivo setup due to ultrasound attenuation and the effect of surrounding tissue. Therefore, the results of the performed study suggest that SWE could be used in a safe manner for arterial applications even though specific effects of high strain rates are to be explored.

Place, publisher, year, edition, pages
IEEE Computer Society, 2017
Series
IEEE International Ultrasonics Symposium, IUS, ISSN 1948-5719
Keywords
Acoustic radiation force, Artery, Safety, Shear wave elastography, Strain, Strain rate
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:kth:diva-220744 (URN)10.1109/ULTSYM.2017.8091581 (DOI)000416948400025 ()2-s2.0-85039434244 (Scopus ID)9781538633830 (ISBN)
Conference
2017 IEEE International Ultrasonics Symposium, IUS 2017, Washington, United States, 6 September 2017 through 9 September 2017
Funder
Swedish Research Council, 2015-04237
Note

QC 20180105

Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-12Bibliographically approved
Maksuti, E., Larsson, D., Urban, M. W., Caidahl, K. & Larsson, M. (2017). Strain and strain rate generated by shear wave elastography in ex vivo porcine aortas. In: IEEE International Ultrasonics Symposium, IUS: . Paper presented at 2017 IEEE International Ultrasonics Symposium, IUS 2017, 6 September 2017 through 9 September 2017. IEEE Computer Society
Open this publication in new window or tab >>Strain and strain rate generated by shear wave elastography in ex vivo porcine aortas
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2017 (English)In: IEEE International Ultrasonics Symposium, IUS, IEEE Computer Society , 2017Conference paper, Published paper (Refereed)
Abstract [en]

In shear wave elastography (SWE), acoustic radiation forces (ARF) are employed to generate shear waves within the tissue. Although the transmitted pulses are longer than those in conventional clinical ultrasound, they typically obey the mechanical and thermal regulatory limits. In arterial applications, specific safety concerns may arise, as ARF-induced stresses and strain rates could potentially affect the arterial wall. A previous simulation study (Doherty et al., J Biomech, 2013 Jan; 46(1):83-90) showed that stresses imposed by the ARF used in SWE are orders of magnitude lower than those caused by blood pressure. ARF-induced strain rates have not been investigated yet, therefore the aim of this study was to assess such strain rates in an ex vivo setup.

Place, publisher, year, edition, pages
IEEE Computer Society, 2017
National Category
Medical Equipment Engineering
Identifiers
urn:nbn:se:kth:diva-227077 (URN)10.1109/ULTSYM.2017.8092757 (DOI)2-s2.0-85039461127 (Scopus ID)9781538633830 (ISBN)
Conference
2017 IEEE International Ultrasonics Symposium, IUS 2017, 6 September 2017 through 9 September 2017
Note

QC 20180518

Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2018-05-18Bibliographically approved
Fröberg, Å., Cissé, A.-S., Larsson, M., Mårtensson, M., Peolsson, M., Movin, T. & Arndt, A. (2016). Altered patterns of displacement within the Achilles tendon following surgical repair.. Knee Surgery, Sports Traumatology, Arthroscopy
Open this publication in new window or tab >>Altered patterns of displacement within the Achilles tendon following surgical repair.
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2016 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Ultrasound speckle tracking was used to compare tendon deformation patterns between uninjured and surgically repaired Achilles tendons at 14-27-month follow-up. The hypothesis was that the non-homogenous displacement pattern previously described in uninjured tendons, where displacement within deep layers of the tendons exceeds that of superficial layers, is altered following tendon rupture and subsequent surgical repair.

METHODS: In the first part of this study, an in-house-developed block-matching speckle tracking algorithm was evaluated for assessment of displacement on porcine flexor digitorum tendons. Displacement data from speckle tracking were compared to displacement data from manual tracking. In the second part of the study, eleven patients with previous unilateral surgically treated Achilles tendon rupture were investigated using ultrasound speckle tracking. The difference in superficial and deep tendon displacement was assessed. Displacement patterns in the surgically repaired and uninjured tendons were compared during passive motion (Thompson's squeeze test) and during active ankle dorsiflexion.

RESULTS: The difference in peak displacement between superficial and deep layers was significantly (p < 0.01) larger in the uninjured tendons as compared to the surgically repaired tendons both during Thompson's test (-0.7 ± 0.2 mm compared to -0.1 ± 0.1 mm) and active dorsiflexion (3.3 ± 1.1 mm compared to 0.3 ± 0.2 mm). The evaluation of the speckle tracking algorithm showed correlations of r ≥ 0.89 between displacement data acquired from speckle tracking and the reference displacement acquired from manual tracking. Speckle tracking systematically underestimated the magnitude of displacement with coefficients of variation of less than 11.7%.

CONCLUSIONS: Uninjured Achilles tendons display a non-uniform displacement pattern thought to reflect gliding between fascicles. This pattern was altered after a mean duration of 19 ± 4 months following surgical repair of the tendon indicating that fascicle sliding is impaired. This may affect modulation of the action between different components of the triceps surae, which in turn may affect force transmission and tendon elasticity resulting in impaired function and risk of re-rupture.

Place, publisher, year, edition, pages
Springer, 2016
Keywords
Achilles tendon, Deformation pattern, Rupture, Speckle tracking, Surgical repair
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-205228 (URN)10.1007/s00167-016-4394-5 (DOI)000402729500024 ()28004174 (PubMedID)
Note

QC 20170419

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2017-07-03Bibliographically approved
Larsson, D., Roy, J., Gasser, T. C., Urban, M. W., Colarieti-Tosti, M. & Larsson, M. (2016). An ex-vivo setup for characterization of atherosclerotic plaque using shear wave elastography and micro-computed tomography. In: IEEE International Ultrasonics Symposium, IUS: . Paper presented at 2016 IEEE International Ultrasonics Symposium, IUS 2016; Tours; France; 18 September 2016 through 21 September 2016. IEEE conference proceedings, Article ID 7728810.
Open this publication in new window or tab >>An ex-vivo setup for characterization of atherosclerotic plaque using shear wave elastography and micro-computed tomography
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2016 (English)In: IEEE International Ultrasonics Symposium, IUS, IEEE conference proceedings, 2016, article id 7728810Conference paper, Published paper (Refereed)
Abstract [en]

Quantification of the mechanical properties of atherosclerotic plaque has shown to be important in assessing carotid artery plaque vulnerability. For such, shear wave elastography (SWE) has been applied on both in-vitro and in-vivo setups. The aim of this study was to build an ex-vivo setup for combined evaluation of plaque characteristics using SWE and micro-computed tomography (μCT). As a proof-of-concept of the constructed experimental setup, a single human carotid plaque specimen was extracted during carotid endarterectomy. The plaque was imaged in the μCT system, and subsequently imaged using SWE. For the SWE measurement, group and phase velocity was extracted from the obtained in-phase/quadrature data, with its spatial distribution being compared to anatomical features visible in the μCT images. The results indicated wave velocity changes at boundaries identified in the μCT, with group velocity data slightly increasing when entering a calcified nodule. Additionally, μCT images seemed to provide good contrast between several plaque constituens using the defined imaging settings. Overall, the study represents a proof-of-concept for detailed ex-vivo plaque analysis using combined SWE and μCT, with obtained wave speed and shear modulus values falling within observed values for atherosclerotic plaque tissue. With an experimental setup defined, future studies on carotid plaque behaviour both in SWE and μCT is enabled, where a large-scale plaque study could be performed to investigate the ability of SWE to differentiate between different plaque types.

Place, publisher, year, edition, pages
IEEE conference proceedings, 2016
Keywords
Atherosclerosis, Carotid, micro-Computed Tomography, Plaque, Shear Wave Elastography, Computerized tomography, Medical imaging, Shear waves, Tomography, Wave propagation, Microcomputed tomography, Shear flow
National Category
Medical Engineering
Identifiers
urn:nbn:se:kth:diva-202279 (URN)10.1109/ULTSYM.2016.7728810 (DOI)2-s2.0-84996486771 (Scopus ID)9781467398978 (ISBN)
Conference
2016 IEEE International Ultrasonics Symposium, IUS 2016; Tours; France; 18 September 2016 through 21 September 2016
Note

Correspondence Address: Larsson, D.; Department of Medical Engineering, KTH Royal Institute of Technology, Hälsovägen 11C, Sweden; email: david.larsson@sth.kth.se. QC 20170221

Available from: 2017-02-21 Created: 2017-02-21 Last updated: 2019-08-23Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-5795-9867

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