Volume Flow. Volume Flow
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1 Volume Flow Jonathan M. Rubin, M.D., Ph.D. Department of Radiology Volume Flow Technique initially described by Hottenger and Meindl in 1974 Describes method for measuring the total flux across a flow tube At the time, this method was not practicable. 1
2 Volume Flow Actually first described by Gauss: Just like almost everything. Present Volume Flow Method Many limitations and assumptions. Present assumptions and properties: Angle dependent Assume circular vessel cross-section Assume a cylindrically symmetric flow profile Time dependent 2
3 Color Flow Imaging Elevationally Swept Color Flow Imaging 3
4 Constant Depth Plane Constant Depth Surface 4
5 Constant Depth Surface C-plane - Torus surface (doughnut) imaging angle (lateral) sweep angle (elevational) 5
6 C-plane - Torus surface (doughnut) Results - varying flow Measured flow [ml/s] 95% confidence interval two realizations: X = aperture tube O = aperture ǁ tube line fit: Y = (1.09±0.06) X - (0.36±0.52) Pump setting [ml/s] 6
7 Pulsatile Inputs - Phantom Carotid Femoral Pulsatile Flow - Phantom Carotid Flow Femoral Flow 7
8 Law of Large Numbers This is only necessary at the present degree because of the requirement of using a mechanical scanhead for elevational sampling. Pulsatile Flow - Phantom 8
9 Femoral Artery - Dog Flow in Dog Femorals and Carotids R 2 = R 2 = when forced through zero Mean error = % FWHM = ± 13.4% 9
10 Medical Applications Cardiac Output and Stroke Volume Renal or Hepatic TIPS Including perfusion measurements Transplants Umbilical cord Cerebral blood flow Peripheral run-off studies Aortic aneurysm assessments Dialysis shunt evaluations Anywhere were flow indices e.g. RI, PI, S/D are presently used. Medical Applications Cardiac Output Renal or Hepatic TIPS Umbilical cord 10
11 Cardiac Output Cardiac Output 11
12 Cardiac Output Ge et al. J Am Soc Echocardiogr 2005;18:1-7. Medical Applications Cardiac Output Renal or Hepatic TIPS Umbilical cord 12
13 Transjugular Intrahepatic Portalsystemic Shunt - TIPS TIPS = Short circuit between portal and systemic venous circulations 2010 California Pacific Medical Center. All rights reserved Ultrasound of TIPS 13
14 Ultrasound of TIPS Ultrasound is primary way to evaluate TIPs. Present best result is flow or no flow. Evaluation criteria are based on flawed assumptions. Examples: Absolute Velocity < 50 cm/sec Absolute Velocity > cm/sec Time < cm/sec Time > 60 cm/sec max and min velocity > 100 cm/sec Perfect application No bifurcations Flow change is desired parameter Easy access 14
15 Medical Applications Cardiac Output Renal or Hepatic TIPS Umbilical cord Umbilical Cord Flow Holy Grail of parameter of fetal well-being Placental blood flow in fetus cardiopulmonary flow in adults Measurement of venous blood flow in the human fetus: a dream comes true, but now for some standardization Ferrazzi Primary diagnostic criteria for IUGR. Using present techniques cord volume flow is very hard to measure Multiple surrogates presently used. 15
16 Which diameter? Which angle? Which flow? Umbilical Cord Flow Perfect geometry Multiple areas for access No clutter background Internal control artery = vein Routine component of Ob exams! 16
17 Umbilical Cord Umbilical Cord Our Data Compromised Control False Negative Tchirikov M et al. Ultrasound Obstet Gynecol 2002; 20:
18 Thanks! 18
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