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Fullwave simulations are applied to an intercostal imaging scenario todetermine the sources of fundamental and harmonic image degradation withrespect to aberration and reverberation. These simulations are based on Part Iof this two part paper, which established the Fullwave simulation methods togenerate realistic ultrasound images based directly on the first principles ofwave propagation in the human body. The ultasound images are generated based onthe first principles of propagation and reflection and they describe interplaybetween distributed aberration and reverberation clutter. Three imagingscenarios that would not be realizable in vivo are investigated in silico.First, the ribs were completely removed and replaced with fat. Then, the ribswere maintained in their anatomically correct configuration to yield areference image. Finally the ribs were placed closer together in elevation. Thepropagation based B-mode images show that of these three scenarios the second,anatomically correct configuration, has the best contrast-to-noise ratio. Thisis due to two competing effects. First the ribs effectively apodize thefundamental and harmonic beams by 3-5 dB. This effect alone would predict animprovement in image quality. However, the B-mode image quality, measured bythe contrast-to-noise ratio degrades by 8%. To explain these changes, it isshown that a second effect, multiple reverberation, must be taken into account.A point spread function analysis shows that when the ribs are placed closertogether they generate significantly more reverberation clutter (by 2.4 to 2.9dB), degrading the image quality even though the beamplot has lower sidelobes.In this intercostal imaging scenario the effects of the ribs on beam shape andreverberation are therefore in competition in terms of image quality and thereis an optimal acoustic window that balances them out.

Ultrasound imaging with three dimensional full-wave nonlinear acoustic simulations. Part 2: sources of image degradation in intercostal imaging