Gaseous microemboli sizing in extracorporeal circuits using ultrasound backscatter

This paper describes efforts to estimate the size of gaseous microemboli (GME) in extracorporeal blood circuits based on the amplitude of backscattered ultrasound, starting with analytic modeling of the scattering behavior of GME in blood. After neglecting resonance effects, this model predicts a linear relationship between the amplitude of backscattered echoes and the diameter of GME. Computer simulations based on the cylindrical acoustic finite integration technique were performed to test some of the simplifying assumptions of the analytical model, with the simulations predicting small deviations from the linear approximation that could be treated as random scatter. Ultrasonic and microscopic measurements of injected GME were then performed on a test circuit to determine the linear correlation coefficient between echo amplitude and GME diameter in conditions like those employed in real cardiopulmonary bypass (CPB) circuits. The correlation coefficient determined through this study was further validated in a closed-loop CPB circuit using canine blood. This study shows that the amplitude of ultrasonic backscattered echoes can be used to accurately estimate the size distribution of a population of detected GME when the spacing of emboli is great enough to minimize interference and other multi-path scattering effects. With the high flow rates found in CPB circuits, typically ranging from 2 to 6 L per minute (equivalent to a flow velocity of 0.3 to 1 m/s through the circuit tubing), this assumption will be valid even when hundreds of emboli per second pass through the circuit. Therefore, sizing of GME using the ultrasonic backscatter models described in this paper is a viable method for estimating embolic load delivered to a patient during a CPB procedure.