{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:01:03Z","timestamp":1787162463107,"version":"build-2736575974"},"reference-count":64,"publisher":"Acoustical Society of America (ASA)","issue":"5","content-domain":{"domain":["pubs.aip.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:p>Although ultrasound cannot penetrate a tissue\/air interface, it images the lung with high diagnostic accuracy. Lung ultrasound imaging relies on the interpretation of \u201cartifacts,\u201d which arise from the complex reverberation physics occurring at the lung surface but appear deep inside the lung. This physics is more complex and less understood than conventional B-mode imaging in which the signal directly reflected by the target is used to generate an image. Here, to establish a more direct relationship between the underlying acoustics and lung imaging, simulations are used. The simulations model ultrasound propagation and reverberation in the human abdomen and at the tissue\/air interfaces of the lung in a way that allows for direct measurements of acoustic pressure inside the human body and various anatomical structures, something that is not feasible clinically or experimentally. It is shown that the B-mode images beamformed from these acoustical simulations reproduce primary clinical features that are used in diagnostic lung imaging, i.e., A-lines and B-lines, with a clear relationship to known underlying anatomical structures. Both the oblique and parasagittal views are successfully modeled with the latter producing the characteristic \u201cbat sign,\u201d arising from the ribs and intercostal part of the pleura. These simulations also establish a quantitative link between the percentage of fluid in exudative regions and the appearance of B-lines, suggesting that the B-mode may be used as a quantitative imaging modality.<\/jats:p>","DOI":"10.1121\/10.0007273","type":"journal-article","created":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T08:51:13Z","timestamp":1637571073000},"page":"3904-3913","update-policy":"https:\/\/doi.org\/10.1063\/aip-crossmark-policy-page","source":"Crossref","is-referenced-by-count":16,"title":["Diagnostic ultrasound imaging of the lung: A simulation approach based on propagation and reverberation in the human body"],"prefix":"10.1121","volume":"150","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-5792","authenticated-orcid":false,"given":"Oleksii","family":"Ostras","sequence":"first","affiliation":[{"name":"Joint Department of Biomedical Engineering of the University of North Carolina at Chapel Hill and North Carolina State University , Chapel Hill, North Carolina 27514, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7507-0391","authenticated-orcid":false,"given":"Danai Eleni","family":"Soulioti","sequence":"additional","affiliation":[{"name":"Joint Department of Biomedical Engineering of the University of North Carolina at Chapel Hill and North Carolina State University , Chapel Hill, North Carolina 27514, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmarco","family":"Pinton","sequence":"additional","affiliation":[{"name":"Joint Department of Biomedical Engineering of the University of North Carolina at Chapel Hill and North Carolina State University , Chapel Hill, North Carolina 27514, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"231","published-online":{"date-parts":[[2021,11,22]]},"reference":[{"issue":"11","key":"2023073102012270300_c1","doi-asserted-by":"publisher","first-page":"181","DOI":"10.3238\/arztebl.2014.0181","article-title":"Radiological diagnosis in lung disease: Factoring treatment options into the choice of diagnostic modality","volume":"111","year":"2014","journal-title":"Dtsch. Arztebl. Int."},{"issue":"8","key":"2023073102012270300_c2","doi-asserted-by":"publisher","first-page":"e19673","DOI":"10.2196\/19673","article-title":"Diagnostic value of imaging modalities for COVID-19: Scoping review","volume":"22","year":"2020","journal-title":"J. Med. Internet Res."},{"issue":"1","key":"2023073102012270300_c3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2110-5820-4-1","article-title":"Lung ultrasound in the critically ill","volume":"4","year":"2014","journal-title":"Ann. Intensive Care"},{"key":"2023073102012270300_c4","volume-title":"Ultrasound Physics and Instrumentation","year":"2005","edition":"4th ed"},{"issue":"11","key":"2023073102012270300_c5","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1002\/ejhf.417","article-title":"Lung congestion in chronic heart failure: Haemodynamic, clinical, and prognostic implications","volume":"17","year":"2015","journal-title":"Eur. J. Heart Failure"},{"issue":"11","key":"2023073102012270300_c6","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1016\/j.jcmg.2013.08.004","article-title":"Lung ultrasound for the evaluation of pulmonary congestion in outpatients","volume":"6","year":"2013","journal-title":"JACC: Cardiovasc. Imaging"},{"issue":"2","key":"2023073102012270300_c7","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1097\/CCM.0000000000004124","article-title":"Comparative performance of pulmonary ultrasound, chest radiograph, and CT among patients with acute respiratory failure","volume":"48","year":"2020","journal-title":"Crit. Care Med."},{"issue":"27","key":"2023073102012270300_c8","doi-asserted-by":"publisher","first-page":"2097","DOI":"10.1093\/eurheartj\/ehw164","article-title":"Ultrasound of extravascular lung water: A new standard for pulmonary congestion","volume":"37","year":"2016","journal-title":"Eur. Heart J."},{"issue":"10","key":"2023073102012270300_c9","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1016\/j.echo.2008.08.001","article-title":"Chest sonography detects lung water accumulation in healthy elite apnea divers","volume":"21","year":"2008","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"2023073102012270300_c10","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1002\/jum.15580","article-title":"On the impact of different lung ultrasound imaging protocols in the evaluation of patients affected by coronavirus disease 2019","volume":"40","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"2023073102012270300_c11","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.1002\/jum.15548","article-title":"A new lung ultrasound protocol able to predict worsening in patients affected by severe acute respiratory syndrome coronavirus 2 pneumonia","volume":"40","year":"2021","journal-title":"J. Ultrasound Med."},{"issue":"1","key":"2023073102012270300_c12","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12947-017-0113-8","article-title":"Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit?","volume":"15","year":"2017","journal-title":"Cardiovasc. Ultrasound"},{"issue":"1","key":"2023073102012270300_c13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12245-018-0170-2","article-title":"Diagnostic use of lung ultrasound compared to chest radiograph for suspected pneumonia in a resource-limited setting","volume":"11","year":"2018","journal-title":"Int. J. Emerg. Med."},{"issue":"9","key":"2023073102012270300_c14","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1007\/s00134-019-05725-8","article-title":"Thoracic ultrasonography: A narrative review","volume":"45","year":"2019","journal-title":"Intensive Care Med."},{"issue":"8","key":"2023073102012270300_c15","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1007\/s11547-020-01236-5","article-title":"The lung ultrasound: Facts or artifacts? In the era of COVID-19 outbreak","volume":"125","year":"2020","journal-title":"Radiol. Med."},{"issue":"4","key":"2023073102012270300_c16","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s00134-012-2513-4","article-title":"International evidence-based recommendations for point-of-care lung ultrasound","volume":"38","year":"2012","journal-title":"Intensive Care Med."},{"issue":"2","key":"2023073102012270300_c17","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1080\/17476348.2019.1565997","article-title":"The role of ultrasound lung artifacts in the diagnosis of respiratory diseases","volume":"13","year":"2019","journal-title":"Expert Rev. Respir. Med."},{"issue":"9","key":"2023073102012270300_c18","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1002\/ejhf.839","article-title":"Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: A systematic review","volume":"19","year":"2017","journal-title":"Eur. J. Heart Failure"},{"issue":"2","key":"2023073102012270300_c19","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1378\/chest.130.2.533","article-title":"Chest ultrasonography in lung contusion","volume":"130","year":"2006","journal-title":"Chest"},{"key":"2023073102012270300_c20","doi-asserted-by":"publisher","first-page":"32","DOI":"10.21037\/jeccm.2019.07.03","article-title":"Advances in lung ultrasound in critically ill patients","volume":"3","year":"2019","journal-title":"J. Emerg. Crit. Care Med."},{"issue":"2","key":"2023073102012270300_c21","doi-asserted-by":"publisher","first-page":"173","DOI":"10.7863\/jum.2003.22.2.173","article-title":"Transthoracic sonography of diffuse parenchymal lung disease: The role of comet tail artifacts","volume":"22","year":"2003","journal-title":"J. Ultrasound Med."},{"key":"2023073102012270300_c22","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1476-7120-12-25","article-title":"How I do it: Lung ultrasound","volume":"12","year":"2014","journal-title":"Cardiovasc. Ultrasound"},{"issue":"2","key":"2023073102012270300_c23","doi-asserted-by":"publisher","first-page":"217","DOI":"10.4187\/respcare.06179","article-title":"Lung ultrasound: The emerging role of respiratory therapists","volume":"64","year":"2019","journal-title":"Respir. Care"},{"issue":"11","key":"2023073102012270300_c24","first-page":"1282","article-title":"Lung ultrasound in the ICU: From diagnostic instrument to respiratory monitoring tool","volume":"78","year":"2012","journal-title":"Minerva Anestesiol."},{"issue":"5","key":"2023073102012270300_c25","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1378\/chest.11-0348","article-title":"Thoracic ultrasonography for the pulmonary specialist","volume":"140","year":"2011","journal-title":"Chest"},{"issue":"1","key":"2023073102012270300_c26","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/S0929-6441(08)60002-8","article-title":"Clinical applications of transthoracic ultrasound in chest medicine","volume":"16","year":"2008","journal-title":"J. Med. Ultrasound"},{"issue":"5","key":"2023073102012270300_c27","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1378\/chest.108.5.1345","article-title":"A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding","volume":"108","year":"1995","journal-title":"Chest"},{"issue":"6","key":"2023073102012270300_c28","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1164\/rccm.201802-0236CI","article-title":"Lung ultrasound for critically ill patients","volume":"199","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"issue":"7","key":"2023073102012270300_c29","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1002\/jum.15285","article-title":"Proposal for international standardization of the use of lung ultrasound for patients with COVID-19: A simple, quantitative, reproducible method","volume":"39","year":"2020","journal-title":"J. Ultrasound Med."},{"issue":"3","key":"2023073102012270300_c30","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1590\/S1679-45082016MD3557","article-title":"Advances in lung ultrasound","volume":"14","year":"2016","journal-title":"Einstein"},{"key":"2023073102012270300_c31","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1476-7120-6-16","article-title":"Chest sonography: A useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome","volume":"6","year":"2008","journal-title":"Cardiovasc. Ultrasound"},{"issue":"3","key":"2023073102012270300_c32","doi-asserted-by":"publisher","first-page":"250","DOI":"10.4103\/0970-2113.156245","article-title":"Lung ultrasound: Present and future","volume":"32","year":"2015","journal-title":"Lung India"},{"key":"2023073102012270300_c33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2373997515610270","article-title":"Ultrasonographic evaluation of the pleura","volume":"2","year":"2015","journal-title":"PLEURA"},{"key":"2023073102012270300_c34","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1007\/s12630-018-1062-x","article-title":"The sound of air: Point-of-care lung ultrasound in perioperative medicine","volume":"65","year":"2018","journal-title":"Can. J. Anesth.\/J. Can. Anesth."},{"issue":"2","key":"2023073102012270300_c35","doi-asserted-by":"publisher","first-page":"462","DOI":"10.3390\/app10020462","article-title":"Lung ultrasound imaging, a technical review","volume":"10","year":"2020","journal-title":"Appl. Sci."},{"issue":"10","key":"2023073102012270300_c36","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.7863\/ultra.15.08023","article-title":"On the physical basis of pulmonary sonographic interstitial syndrome","volume":"35","year":"2016","journal-title":"J. Ultrasound Med."},{"issue":"1","key":"2023073102012270300_c37","doi-asserted-by":"publisher","first-page":"12746","DOI":"10.1038\/s41598-017-13078-9","article-title":"Determination of a potential quantitative measure of the state of the lung using lung ultrasound spectroscopy","volume":"7","year":"2017","journal-title":"Sci. Rep."},{"issue":"2","key":"2023073102012270300_c38","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1121\/10.0001797","article-title":"On the influence of imaging parameters on lung ultrasound B-line artifacts, in vitro study","volume":"148","year":"2020","journal-title":"J. Acoust. Soc. Am."},{"issue":"2","key":"2023073102012270300_c39","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1121\/10.0001723","article-title":"Real-time multi-frequency ultrasound imaging for quantitative lung ultrasound\u2014First clinical results","volume":"148","year":"2020","journal-title":"J. Acoust. Soc. Am."},{"issue":"11","key":"2023073102012270300_c40","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.1109\/TUFFC.2020.3012289","article-title":"Quantitative lung ultrasound spectroscopy applied to the diagnosis of pulmonary fibrosis: The first clinical study","volume":"67","year":"2020","journal-title":"IEEE Trans. Ultrason., Ferroelectr., Freq. Control"},{"issue":"5","key":"2023073102012270300_c41","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1016\/j.ultrasmedbio.2017.01.011","article-title":"Characterization of the lung parenchyma using ultrasound multiple scattering","volume":"43","year":"2017","journal-title":"Ultrasound Med. Biol."},{"issue":"4","key":"2023073102012270300_c42","doi-asserted-by":"publisher","first-page":"2304","DOI":"10.1121\/10.0003930","article-title":"Numerical study on lung ultrasound B-line formation as a function of imaging frequency and alveolar geometries","volume":"149","year":"2021","journal-title":"J. Acoust. Soc. Am."},{"issue":"6","key":"2023073102012270300_c43","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1109\/TUFFC.2011.1938","article-title":"Sources of image degradation in fundamental and harmonic ultrasound imaging using nonlinear, full-wave simulations","volume":"58","year":"2011","journal-title":"IEEE Trans. Ultrason., Ferroelectr., Freq. Control"},{"issue":"3","key":"2023073102012270300_c44","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1109\/TUFFC.2009.1066","article-title":"A heterogeneous nonlinear attenuating full-wave model of ultrasound","volume":"56","year":"2009","journal-title":"IEEE Trans. Ultrason., Ferroelectr., Freq. Control"},{"issue":"1","key":"2023073102012270300_c45","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1118\/1.3670376","article-title":"Numerical prediction of frequency dependent 3D maps of mechanical index thresholds in ultrasonic brain therapy","volume":"39","year":"2011","journal-title":"Med. Phys."},{"issue":"4","key":"2023073102012270300_c46","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1109\/TUFFC.2012.2243","article-title":"Harmonic spatial coherence imaging: An ultrasonic imaging method based on backscatter coherence","volume":"59","year":"2012","journal-title":"IEEE Trans. Ultrason., Ferroelectr., Freq. Control"},{"key":"2023073102012270300_c47","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1118\/1.3668316","article-title":"Attenuation, scattering and absorption of ultrasound in the skull bone","volume":"39","year":"2011","journal-title":"Med. Phys."},{"issue":"6","key":"2023073102012270300_c48","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1109\/TUFFC.2012.2305","article-title":"Direct phase projection and transcranial focusing of ultrasound for brain therapy","volume":"59","year":"2012","journal-title":"IEEE Trans. Ultrason., Ferroelectr., Freq. Control"},{"issue":"12","key":"2023073102012270300_c49","doi-asserted-by":"publisher","first-page":"1976","DOI":"10.1109\/TUFFC.2014.006362","article-title":"Spatial coherence in human tissue: Implications for imaging and measurement","volume":"61","year":"2014","journal-title":"IEEE Trans. Ultrason., Ferroelectr., Freq. Control"},{"issue":"3","key":"2023073102012270300_c50","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1109\/TUFFC.2016.2638801","article-title":"Subresolution displacements in finite difference simulations of ultrasound propagation and imaging","volume":"64","year":"2017","journal-title":"IEEE Trans. Ultrason., Ferroelectr., Freq. Control"},{"issue":"4","key":"2023073102012270300_c51","doi-asserted-by":"publisher","first-page":"044024","DOI":"10.1103\/PhysRevApplied.8.044024","article-title":"Shear shock waves observed in the brain","volume":"8","year":"2017","journal-title":"Phys. Rev. Appl."},{"issue":"5","key":"2023073102012270300_c52","doi-asserted-by":"publisher","first-page":"3610","DOI":"10.1121\/1.4987734","article-title":"Beamforming methods for large aperture imaging","volume":"141","year":"2017","journal-title":"J. Acoust. Soc. Am."},{"key":"2023073102012270300_c53","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1109\/TUFFC.2019.2952797","article-title":"The impact of acoustic clutter on large array abdominal imaging","volume":"67","year":"2020","journal-title":"IEEE Trans. Ultrason., Ferroelectr., Freq. Control"},{"key":"2023073102012270300_c54","unstructured":"G.\u2008Pinton, \u201cUltrasound imaging of the human body with three dimensional full-wave nonlinear acoustics. Part 1: Simulations methods,\u201d arXiv:2003.06934 (2020)."},{"key":"2023073102012270300_c55","unstructured":"G.\u2008Pinton, \u201cUltrasound imaging with three dimensional full-wave nonlinear acoustic simulations. Part 2: Sources of image degradation in intercostal imaging,\u201d arXiv:2003.06927 (2020)."},{"key":"2023073102012270300_c56","doi-asserted-by":"crossref","unstructured":"S.\u2008Chandrasekaran, B.\u2008Tripathi, D.\u2008Esp\u00edndola, and G.\u2008Pinton, \u201cModeling ultrasound propagation in the moving brain: Applications to shear shock waves and traumatic brain injury,\u201d arXiv:2003.06446 (2020).","DOI":"10.1109\/TUFFC.2020.3022567"},{"issue":"2","key":"2023073102012270300_c57","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1136\/jamia.1996.96236280","article-title":"The visible human male: A technical report","volume":"3","year":"1996","journal-title":"J. Am. Med. Inf. Assoc."},{"key":"2023073102012270300_c58","article-title":"Deconstruction and reconstruction of image-degrading effects in the human abdomen using fullwave: Phase aberration, multiple reverberation, and trailing reverberation","year":"2021"},{"key":"2023073102012270300_c59","article-title":"A fullwave model of the nonlinear wave equation with multiple relaxations and relaxing perfectly matched layers for high-order numerical finite-difference solutions","year":"2021"},{"issue":"2","key":"2023073102012270300_c60","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1148\/radiol.2392041968","article-title":"Thin-section CT of the secondary pulmonary lobule: Anatomy and the image\u2014The 2004 Fleischner lecture","volume":"239","year":"2006","journal-title":"Radiology"},{"key":"2023073102012270300_c61","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1164\/rccm.200308-1107OC","article-title":"The number of alveoli in the human lung","volume":"169","year":"2004","journal-title":"Am. J. Respir. Crit. Care Med."},{"issue":"6","key":"2023073102012270300_c62","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.21037\/jtd.2016.04.55","article-title":"Lung B-line artefacts and their use","volume":"8","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"2023073102012270300_c63","unstructured":"See supplementary material at https:\/\/www.scitation.org\/doi\/suppl\/10.1121\/10.0007273 for the video file of the propagation of sound in the areas of reduced aeration. The pressure field is shown on a compressed scale to facilitate the visualization of the low pressure signal."},{"issue":"3","key":"2023073102012270300_c64","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1177\/016173468300500301","article-title":"The improvement and quantitative assessment of B-mode images produced by an annular array\/cone hybrid","volume":"5","year":"1983","journal-title":"Ultrasonic Imaging"}],"container-title":["The Journal of the Acoustical Society of America"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.aip.org\/asa\/jasa\/article-pdf\/150\/5\/3904\/16706485\/3904_1_online.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.aip.org\/asa\/jasa\/article-pdf\/150\/5\/3904\/16706485\/3904_1_online.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,30]],"date-time":"2023-07-30T22:01:32Z","timestamp":1690754492000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.aip.org\/jasa\/article\/150\/5\/3904\/903559\/Diagnostic-ultrasound-imaging-of-the-lung-A"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,1]]},"references-count":64,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,11,1]]}},"URL":"https:\/\/doi.org\/10.1121\/10.0007273","relation":{},"ISSN":["0001-4966","1520-8524"],"issn-type":[{"value":"0001-4966","type":"print"},{"value":"1520-8524","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,11]]},"published":{"date-parts":[[2021,11,1]]}}}