As a well-known medical imaging methodology, intravascular ultrasound (IVUS) imaging plays a critical role in diagnosis, treatment guidance and post-treatment assessment of coronary artery diseases. By cannulating a miniature ultrasound transducer mounted catheter into an artery, the vessel lumen opening, vessel wall morphology and other associated blood and vessel properties can be precisely assessed in IVUS imaging. Ultrasound transducer, as the key component of an IVUS system, is critical in determining the IVUS imaging performance. In recent years, a wide range of achievements in ultrasound transducers have been reported for IVUS imaging applications. Herein, a comprehensive review is given on recent advances in ultrasound transducers for IVUS imaging. Firstly, a fundamental understanding of IVUS imaging principle, evaluation parameters and IVUS catheter are summarized. Secondly, three different types of ultrasound transducers (piezoelectric ultrasound transducer, piezoelectric micromachined ultrasound transducer and capacitive micromachined ultrasound transducer) for IVUS imaging are presented. Particularly, the recent advances in piezoelectric ultrasound transducer for IVUS imaging are extensively examined according to their different working mechanisms, configurations and materials adopted. Thirdly, IVUS-based multimodality intravascular imaging of atherosclerotic plaque is discussed. Finally, summary and perspectives on the future studies are highlighted for IVUS imaging applications.

Due to the rapid developments in materials science and fabrication techniques, wearable devices have recently received increased attention for biomedical applications, particularly in medical ultrasound imaging, sensing, and therapy. Ultrasound is ubiquitous in biomedical applications because of its non-invasive nature, nonionic radiating, high precision, and real-time capabilities. While conventional ultrasound transducers are rigid and bulky, flexible transducers can be conformed to curved body areas for continuous sensing without restricting tissue movement or transducer shifting. This article comprehensively reviews the application of flexible ultrasound transducers in the field of biomedical imaging, sensing, and therapy. First, we review the background of flexible ultrasound transducers. Following that, we discuss advanced materials and fabrication techniques for flexible ultrasound transducers and their enabling technology status. Lastly, we highlight and summarize some promising preliminary data with recent applications of flexible ultrasound transducers in biomedical imaging, sensing, and therapy. We also provide technical barriers, challenges, and future perspectives for further research and development.

Thrombo-occlusive disease is one of the leading causes of death worldwide. There has been active research on safe and effective thrombolysis in preclinical and clinical studies. Recently, the dual-frequency transcutaneous sonothrombolysis with contrast agents [microbubbles (MBs)] has been reported to be more efficient in trigging the acoustic cavitation, which leads to a higher lysis rate. Therefore, there is increasing interest in applying dual-frequency technique for more significant efficacy improvement in intravascular sonothrombolysis since a miniaturized intravascular ultrasound transducer typically has a limited power output to fully harness cavitation effects. In this work, we demonstrated this efficacy enhancement by developing a new broadband intravascular transducer and testing dual-frequency sonothromblysis in vitro . A broadband intravascular transducer with a center frequency of 750 kHz and a footprint size of 1.4 mm was designed, fabricated, and characterized. The measured −6-dB fractional bandwidth is 68.1%, and the peak negative pressure is 1.5 MPa under the driving voltage of 80 V _pp . By keeping one frequency component at 750 kHz, the second frequency component was selected from 450 to 650 kHz with an interval of 50 kHz. The in vitro sonothrombolysis tests were conducted with a flow model and the results indicated that the MB-mediated, dual-frequency (750+500 kHz) sonothrombolysis yields an 85% higher lysis rate compared with the single-frequency treatment, and the lysis rate of dual-frequency sonothrombolysis increases with the difference between the two frequency components. These findings suggest a dual-frequency excitation technique for more efficient intravascular sonothrombolysis than conventional single-frequency excitation

Re-poling of unexpected partially depoled piezoelectric materials conventionally needs to be first fully depoled through annealing above their Curie temperature to revive piezoelectric performances. Here, we investigated de-poling and re-poling of Pb(In_1/2Nb_1/2)O₃-Pb(Mg_1/3Nb_2/3)O₃-PbTiO₃ single crystals under electric fields at room temperature. We found that alternating current electric fields with amplitudes near the coercive field at low frequencies (<10 Hz) can be employed to successfully depolarize poled crystals at room temperature. We also demonstrated a reversible polarization switching process with a relaxor-PbTiO₃ single crystal ultrasound transducer without device performance degradations. This experimental observation is supported by phase-field simulation, showing that alternating current electric fields can readily induce de-poling at room temperature, while direct current electric fields induce a transient depoled state only within an uncontrollable short period of time. The findings suggest new strategies for unprecedented in-device tailoring of the polarization states of ferroelectric materials.

Thromboembolism in vessels often leads to stroke or heart attack and even sudden death unless brought under control. Sonothrombolysis based on ultrasound contrast agents has shown promising outcome in effective treatment of thromboembolism. Intravascular sonothrombolysis transducer was reported recently for unprecedented sonothrombolysis in vitro . However, it is necessary to provide an imaging guide during thrombolysis in clinical applications for optimal treatment efficiency. In this article, a dual mode ultrasound catheter was developed by combining a 16-MHz high-frequency element (imaging transducer) and a 220-kHz low-frequency element (treatment transducer) for sonothrombolysis in vitro . The treatment transducer was designed with a 20-layer PZT-5A stack with the aperture size of $1.2\times1.2$ mm ² , and the imaging transducer with the aperture size of $1.2\times1.2$ mm ² was attached in front of the treatment transducer. Both transducers were assembled into a customized 2-lm 10-Fr catheter. In vitro experiment was carried out using a bovine blood clot. Imaging tests were conducted, showing that the backscattering signals can be obtained with a high signal-to-noise ratio (SNR) for the 16-MHz imaging transducer. Sonothrombolysis was performed successfully that the volume of clot was reduced significantly after the 30-min treatment. The size changes of clot were observed clearly using the 16-MHz M-mode imaging during the thrombolysis. The findings suggest that the proposed ultrasound-guided intravascular sonothrombolysis can be enhanced since the position of treatment transducer can be adjusted with the target at the clot due to the imaging guide.

Thromboembolism in blood vessels can lead to stroke or heart attack and even sudden death unless brought under control. Sonothrombolysis enhanced by ultrasound contrast agents has shown promising outcome on effective treatment of thromboembolism. Intravascular sonothrombolysis was also reported recently with a potential for effective and safe treatment of deep thrombosis. Despite the promising treatment results, the treatment efficiency for clinical application may not be optimized due to the lack of imaging guidance and clot characterization during the thrombolysis procedure. In this paper, a miniaturized transducer was designed to have an 8-layer PZT-5A stacked with an aperture size of 1.4 ×1.4 mm ² and assembled in a customized two-lumen 10-Fr catheter for intravascular sonothrombolysis. The treatment process was monitored with internal-illumination photoacoustic tomography (II-PAT), a hybrid imaging modality that combines the rich contrast of optical absorption and the deep penetration of ultrasound detection. With intravascular light delivery using a thin optical fiber integrated with the intravascular catheter, II-PAT overcomes the penetration depth limited by strong optical attenuation of tissue. In-vitro PAT-guided sonothrombolysis experiments were carried out with synthetic blood clots embedded in tissue phantom. Clot position, shape, stiffness, and oxygenation level can be estimated by II-PAT at clinically relevant depth of ten centimeters. Our findings have demonstrated the feasibility of the proposed PAT-guided intravascular sonothrombolysis with real-time feedback during the treatment process.