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Ultrasound Equipment

Ultrasound adaptability – A look at the recent advancements

The next generation of ultrasound machines will be automated and mobile to enable effective patient diagnosis and treatment planning.

Since the advent of ultrasound scanning in the 1950s, the global movement to develop and expand its diagnostic features continues in its appeal with the medical community today. The ultrasound design using sound waves and echo reflection became widely accepted for being the safe (non-radiation), inexpensive, repeatable, and non-invasive alternative in medical imaging. Early clinical upgrades included the development of the pulse Doppler paradigm to enable scanning layers of the heart via blood flow. This offered diagnostic advantages to its application in the mid-seventies for live-action scans of the human fetus. These qualities earned its place as the standard in pediatric use while continuing to earn the confidence of radiologists and imaging specialists for a wide range of diagnostic applications, from emergency critical care to supplemental cancer screening.

Ultrasound imaging technology has seen tremendous advancements and improvements in the last two decades. This article covers some of the recent advancements in ultrasound machines used for diagnostic medical imaging – some are already widely commercially available and some are still in developmental stages.

Researchers and clinicians have been working to use focused ultrasound, combined with microbubbles, to open the blood-brain barrier for both noninvasive diagnostic use as well as to deliver treatments to the brain for tumors and neurodegenerative diseases.

Low-cost focused ultrasound. Researchers and clinicians have been working to use focused ultrasound, combined with microbubbles, to open the blood-brain barrier (BBB) for both noninvasive diagnostic use as well as to deliver treatments to the brain for tumors and neurodegenerative diseases. However, the few existing devices for preclinical research are expensive, bulky, and lack the precision needed for small animal research.

Hong Chen, associate professor of biomedical engineering at the McKelvey School of Engineering and of radiation oncology at the School of Medicine at Washington University in St. Louis, and her team have developed a low-cost, easy-to-use, and highly precise focused ultrasound (FUS) device that can be used on small animal models in preclinical research.

The FUS transducer, created in-house using a 3D printer, costs about USD 80 to fabricate. It can be integrated with a commercially available stereotactic frame to precisely target a mouse brain. Results of the work were published online in IEEE Transactions on Biomedical Engineering on February 15, 2022.

The device has several benefits, Chen said, including achieving sub-millimeter targeting accuracy and having a tunable drug-delivery outcome. In addition, using higher-frequency FUS transducers decreased the BBB opening volume, and improved the precision of FUS-BBB opening in targeting individual structures in the mouse brain.

To create the transducer, the team only needed to connect wires to the electrodes on the elements. The rest of the parts were made on a 3D printer. With the use of a stereotactic frame, her team was able to target the exact location they wanted in the brain, which eliminated one of the barriers to more widespread use of the FUS technique. Chen’s team has made the design available on Github. The team used contrast-enhanced MRI to measure the BBB opening volume at different acoustic pressures and evaluated the drug-delivery outcome, using a model drug. The device was shown to be very safe, with a microhemorrhage found in two mice at the highest tested acoustic pressures and no tissue damage found in other groups.

Focused ultrasound uses ultrasonic energy to target tumors or tissue in the brain. Once located, the researchers inject microbubbles into the blood that travel to the targeted tissue then pop, causing small tears of the blood-brain barrier. The ruptures allow drugs to be delivered or biomarkers from a tumor to pass through the blood-brain barrier and release into the blood. Chen and her lab have been perfecting the technique in preclinical models for the past several years. Chen said she hopes this device can reduce the barriers to the adoption of the FUS technique by the broad research community.

Artificial intelligence and ultrasound. Automation of time-consuming tasks, quantification and picking out the ideal image slice from a 3D dataset, visual mapping and annotation of screened anatomy, voice-recognition for hands-free operation, are all being performed through artificial intelligence (AI).

For example, latest version of the Konica Minolta Sonimage HS1 uses AI-voice recognition for hands-free operation. Mindray Resona 7 also enhances clinical research capabilities with its revolutionary V Flow for vascular hemodynamic evaluation and intelligent plane acquisition from 3D datasets for fetal CNS diagnosis.

Philips Epiq systems use AI for advanced organ modeling, image slicing, and proven quantification to help make ultrasound exams easier. It can extract the optimal scanning slice from 3D datasets, visual mapping and annotation of screened anatomy with minimal user intervention.

Vscan Extend GE Healthcare’s handheld, pocket-sized ultrasound, incorporates DiA imaging analysis AI-powered LVivo EF for automated ejection fraction (EF) measurements. EF interpretation today is made through visual estimation based on clinician’s experience. LVivo EF provides clinicians with left ventricle EF scoring and volume measurements, using AI and advanced pattern recognition algorithms, helping even less experienced clinicians making better assessment of EF. Machine learning and AI are expected to make big impact on cardiac imaging in future and make the biggest impact on recent advancements in ultrasound machines.

3D ultrasound. 3D/4D ultrasound is more popular in maternity or obstetric scanning, mainly due to excitement from parents-to-be to see their baby. The slower frame rates and higher price of 3D ultrasound machine and probes may have limited its wider adoption in other areas, but 3D imaging is very useful when used by specialists for procedural planning or guidance. This is because 3D imaging can provide more identifiable anatomical images for clinicians to more accurately plan their intervention or surgery. Example, ultrasound technology is used to help guide catheter procedures in complex anatomy and fetal anomaly testing like chorionic villus sampling. All the vendors today are trying to improve frame rates to increase adoption of 3D. While 2D ultrasound cannot be written off yet, the market share for 3D machines is increasing day-by-day.

Even if 3D imaging is slow to gain ground in applications other than maternity, recent advancements in ultrasound machines include other visualization techniques. Newer ultrasound machines are featuring more complex and advanced technologies for better visualization and diagnosis. Photo-realistic rendering in Philips TrueVue, Radiant Flow, used in fetalHQ heart and vascular analysis software for fetal ultrasound, offered on the GE Voluson E10, high-resolution imaging that automatically adapts to patients’ size and personal physical characteristics or patient’s bio-acoustic variations in tissue density, stiffness and ultrasound beam absorption allowing better penetration without image quality degradation in Siemens Acuson Sequoia system.

PoC ultrasound. The objective of point-of-care (PoC) ultrasounds is quick use by physicians at the patient bed-side. As more and more image manipulation is getting automated or AI enabled, there is less use for plethora of buttons and knobs. The ultrasound consoles are getting more compact by the day, and software applications are getting more complex.

Of all the recent advancements in ultrasound machines, hand-held devices are most striking and exciting even if limited in use. They are almost status symbols for individual clinicians.

Hospitals and clinics outside major metropolitan areas, where imaging is often difficult for patients to obtain, will especially benefit from this advancement. Radiologists and emergency physicians can leverage the new capabilities of handheld ultrasound, such as the telehealth capabilities enabled by this new technology, to improve patient care.

Handheld ultrasound can also consolidate the need for multiple ultrasound probes into one seamless unit, making handheld ultrasound portable and practical in almost all medical settings. Integrated software solutions can connect radiology and emergency physicians as well, allowing for the rapid sharing of information through a robust user interface designed for the provider.

Much as digital advancements in radiology allowed off-site work decades ago, handheld ultrasound and advancements in software will open up new collaborations between radiology and clinicians in remote medical settings. Now, both medical imaging and the expertise to interpret and diagnose studies can be brought to populations that never had access to ultrasound. For example, a physician in a rural clinic could potentially image a patient at the bedside and then send that image to radiology experts in an urban medical center for diagnosis, unlocking a quality of care for rural patients that was unavailable before.

The Covid-19 pandemic showcased other useful applications of handheld ultrasound. With concerns over contamination, associated with moving patients back and forth from radiology, handheld ultrasound became an imaging solution because of its portability as well as ease of decontamination. The tool became ideal for determining the presence of pulmonary Covid as well as determining other causes of respiratory difficulty – e.g., decompensated congestive heart failure and pulmonary embolism – and negating the need for traditional chest X-rays.

Ultrasound transducers. The well-known piezo electric crystal transducers are now giving way to single-crystal, wireless and even dual probe. A single-crystal transducer is characterized by a higher energy-conversion efficiency and higher sensitivity than conventional piezo-ceramic materials; consequently, single-crystal transducers can produce greater uniformity, and stronger penetration. Single-crystal ultrasound transducers are being used for improved resolution and penetration, and highly sensitive and accurate echo detection, among other features.

Shearwave elastography. Elastography is a relatively new imaging modality that maps the elastic properties of soft tissue. It is now increasingly available in premium ultrasound machines.

Workflow automation. Workflow improvements in current-generation ultrasound machines include, automation/semi-automation of measurement, auto-image optimization, reducing repetitive user tasks, support functions like scan assistant and scan coach – aimed at faster processing time and improving efficiency and productivity as well as enabling lesser acquainted physicians to do the scans, rather than radiologists.

Ultrasound will become increasingly more automated, transportable, definitive, and intuitive for users in the not-too-distant future, making it a vital tool for patient diagnosis and treatment.

Industry insiders predict that ultrasound will continue to evolve in the direction of cost-effective technologies that do not sacrifice image quality. Ultrasound will become increasingly more automated, transportable, definitive, and intuitive for users in the not-too-distant future, making it a vital tool for patient diagnosis and treatment.

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