Stephen J. Carter

Ultrasound therapy head configured to couple to an ultrasound imaging probe to facilitate contemporaneous imaging using low intensity ultrasound and treatment using high intensity focused ultrasound

Method and apparatus for the simultaneous use of ultrasound on a probe for imaging and therapeutic purposes. The probe limits the effects of undesirable interference noise in a display by synchronizing high intensity focused ultrasound (HIFU) waves with an imaging transducer to cause the noise to be displayed in an area of the image that does not overlap the treatment site. In one embodiment, the HIFU is first energized at a low power level that does not cause tissue damage, so that the focal point of the HIFU can be identified by a change in the echogenicity of the tissue caused by the HIFU. Once the focal point is properly targeted on a desired treatment site, the power level is increased to a therapeutic level. The location of each treatment site is stored and displayed to the user to enable a plurality of spaced-apart treatment sites to be achieved. As the treatment progresses, any changes in the treatment site can be seen in the real time, noise-free image. A preferred application of the HIFU waves is to cause lesions in blood vessels, so that the supply of nutrients and oxygen to a region, such as a tumor, is interrupted. The tumor will thus eventually be destroyed. In a preferred embodiment, the HIFU is used to treat disorders of the female reproductive system, such as uterine fibroids. The HIFU treatment can be repeated at spaced-apart intervals, until any remaining fibroid tissue is destroyed.

B-mode Ultrasound Versus Color Doppler Twinkling Artifact in Detecting Kidney Stones

PURPOSE To compare color Doppler twinkling artifact and B-mode ultrasonography in detecting kidney stones. PATIENTS AND METHODS Nine patients with recent CT scans prospectively underwent B-mode and twinkling artifact color Doppler ultrasonography on a commercial ultrasound machine. Video segments of the upper pole, interpolar area, and lower pole were created, randomized, and independently reviewed by three radiologists. Receiver operator characteristics were determined. RESULTS There were 32 stones in 18 kidneys with a mean stone size of 8.9±7.5 mm. B-mode ultrasonography had 71% sensitivity, 48% specificity, 52% positive predictive value, and 68% negative predictive value, while twinkling artifact Doppler ultrasonography had 56% sensitivity, 74% specificity, 62% positive predictive value, and 68% negative predictive value. CONCLUSIONS When used alone, B-mode is more sensitive, but twinkling artifact is more specific in detecting kidney stones. This information may help users employ twinkling and B-mode to identify stones and developers to improve signal processing to harness the fundamental acoustic differences to ultimately improve stone detection.

Detection of bleeding in injured femoral arteries with contrast-enhanced sonography.

Objective. The purpose of this study was to investigate the feasibility of detecting acute arterial bleeding by means of contrast‐enhanced sonography. Methods. Puncture injury was produced transcutaneously with an 18‐gauge needle in 26 femoral arteries (13 in the control group and 13 in the contrast‐enhanced group) of rabbits. A sonographic contrast agent (Optison; Mallinckrodt Inc, St Louis, MO) was administered intravenously at a dose of 0.06 to 0.07 mL/kg. Sonography of the femoral arteries was performed before and after injury, both before and after injection of Optison, with B‐mode imaging, color Doppler imaging, and pulse inversion harmonic imaging (PIHI). Results. The specific location of active bleeding could not be visualized in B‐mode and PIHI scans in the control group (no Optison injection). After administration of Optison, the bleeding site was visualized because of the increased echogenicity of the extravasated blood at the puncture site in both B‐mode imaging and PIHI. In color Doppler images, bleeding sites were localized successfully in 84.6% of the cases in the presence of Optison and in 30.8% of the cases without Optison. Histologic examination (light microscopy) of the hematoma confirmed the presence of contrast agent microbubbles in the extravascular space surrounding the artery. Conclusions. Contrast‐enhanced sonography may provide an effective method for detecting arterial bleeding.

Application of the Advanced Communications Technology Satellite to Teleradiology and Real-Time Compressed Ultrasound Video Telemedicine

The authors have investigated the application of the NASA Advanced Communications Technology Satellite (ACTS) to teleradiology and telemedicine using the Jet Propulsion Laboratory (JPL)-developed ACTS Mobile Terminal (AMT) uplink. In this experiment, bidirectional 128, 256, and 384 kbps satellite links were established between the ACTS/AMT, the ACTS in geosynchronous orbit, and the downlink terrestrial terminal at JPL. A terrestrial Integrated Digital Services Network (ISDN) link was established from JPL to the University of Washington Department of Radiology to complete the bidirectional connection. Ultrasound video imagery was compressed in real-time using video codecs adhering to the International Telecommunication Union—Telecommunication Standardization Sector (ITU-T) Recommendation H.261. A 16 kbps in-band audio channel was used throughout. A five-point Likert scale was used to evaluate the quality of the compressed ultrasound imagery at the three transmission bandwidths (128, 256, and 384 kbps). The central question involved determination of the bandwidth requirements to provide sufficient spatial and contrast resolution for the remote visualization of fine- and low-contrast objects. The 384 kbps bandwidth resulted in only slight tiling artifact and fuzziness owing to the quantizer step size; however, these motion artifacts were rapidly resolved in time at this bandwidth. These experiments have demonstrated that real-time compressed ultrasound video imagery can be transmitted over multiple ISDN line bandwidth links with sufficient temporal, contrast, and spatial resolution for clinical diagnosis of multiple disease and pathology states to provide subspecialty consultation and education at a distance.

Focused Ultrasound : Concept for Automated Transcutaneous Control of Hemorrhage in Austere Settings

BACKGROUND High intensity focused ultrasound (HIFU) is being developed for a range of clinical applications. Of particular interest to NASA and the military is the use of HIFU for traumatic injuries because HIFU has the unique ability to transcutaneously stop bleeding. Automation of this technology would make possible its use in remote, austere settings by personnel not specialized in medical ultrasound. Here a system to automatically detect and target bleeding is tested and reported. METHODS The system uses Doppler ultrasound images from a clinical ultrasound scanner for bleeding detection and hardware for HIFU therapy. The system was tested using a moving string to simulate blood flow and targeting was visualized by Schlieren imaging to show the focusing of the HIFU acoustic waves. RESULTS When instructed by the operator, a Doppler ultrasound image is acquired and processed to detect and localize the moving string, and the focus of the HIFU array is electronically adjusted to target the string. Precise and accurate targeting was verified in the Schlieren images. CONCLUSIONS An automated system to detect and target simulated bleeding has been built and tested. The system could be combined with existing algorithms to detect, target, and treat clinical bleeding.

Real-time compressed video ultrasound using the Advanced Communications Technology Satellite

The authors have an in-kind grant from NASA to investigate the application of the Advanced Communications Technology Satellite (ACTS) to teleradiology and telemedicine using the Jet Propulsion Laboratory developed ACTS Mobile Terminal (AMT) uplink. We have recently completed three series of experiments with the ACTS/AMT. Although these experiments were multifaceted, the primary objective was the determination and evaluation of transmitting real- time compressed ultrasound video imagery over the ACTS/AMT satellite link, a primary focus of the authors current ARPA Advanced Biomedical Technology contract. These experiments have demonstrated that real-time compressed ultrasound video imagery can be transmitted over multiple ISDN line bandwidth links with sufficient temporal, contrast and spatial resolution for clinical diagnosis of multiple disease and pathology states to provide subspecialty consultation and education at a distance.

Compressed ultrasound video image quality evaluation using a Likert scale and Kappa statistical analysis

Experiments using NASAs Advanced Communications Technology Satellite were conducted to provide an estimate of the compressed video quality required for preservation of clinically relevant features for the detection of trauma. Bandwidth rates of 128, 256 and 384 kbps were used. A five point Likert scale (1 equals no useful information and 5 equals good diagnostic quality) was used for a subjective preference questionnaire to evaluate the quality of the compressed ultrasound imagery at the three compression rates for several anatomical regions of interest. At 384 kbps the Likert scores (mean plus or minus SD) were abdomen (4.45 plus or minus 0.71), carotid artery (4.70 plus or minus 0.36), kidney (5.0 plus or minus 0.0), liver (4.67 plus or minus 0.58) and thyroid (4.03 plus or minus 0.74). Due to the volatile nature of the H.320 compressed digital video stream, no statistically significant results can be derived through this methodology. As the MPEG standard has at its roots many of the same intraframe and motion vector compression algorithms as the H.261 (such as that used in the previous ACTS/AMT experiments), we are using the MPEG compressed video sequences to best gauge what minimum bandwidths are necessary for preservation of clinically relevant features for the detection of trauma. We have been using an MPEG codec board to collect losslessly compressed video clips from high quality S- VHS tapes and through direct digitization of S-video. Due to the large number of videoclips and questions to be presented to the radiologists and for ease of application, we have developed a web browser interface for this video visual perception study. Due to the large numbers of observations required to reach statistical significance in most ROC studies, Kappa statistical analysis is used to analyze the degree of agreement between observers and between viewing assessment. If the degree of agreement amongst readers is high, then there is a possibility that the ratings (i.e., average Likert score at each bandwidth) do in fact reflect the dimension they are purported to reflect (video quality versus bandwidth). It is then possible to make intelligent choice of bandwidth for streaming compressed video and compressed videoclips.

Application of the advanced communications technology satellite for teleradiology and telemedicine

The authors have an in-kind grant from NASA to investigate the application of the Advanced Communications Technology Satellite (ACTS) to teleradiology and telemedicine using the JPL developed ACTS Mobile Terminal (AMT) uplink. This experiment involves the transmission of medical imagery (CT, MR, CR, US and digitized radiographs including mammograms), between the ACTS/AMT and the University of Washington. This is accomplished by locating the AMT experiment van in various locations throughout Washington state, Idaho, Montana, Oregon and Hawaii. The medical images are transmitted from the ACTS to the downlink at the NASA Lewis Research Center (LeRC) in Cleveland, Ohio, consisting of AMT equipment and the high burst rate-link evaluation terminal (HBR-LET). These images are then routed from LeRC to the University of Washington School of Medicine (UWSoM) through the Internet and public switched Integrated Serviced Digital Network (ISDN). Once images arrive in the UW Radiology Department, they are reviewed using both video monitor softcopy and laser-printed hardcopy. Compressed video teleconferencing and transmission of real-time ultrasound video between the AMT van and the UWSoM are also tested. Image quality comparisons are made using both subjective diagnostic criteria and quantitative engineering analysis. Evaluation is performed during various weather conditions (including rain to assess rain fade compensation algorithms). Compression techniques also are tested to evaluate their effects on image quality, allowing further evaluation of portable teleradiology/telemedicine at lower data rates and providing useful information for additional applications (e.g., smaller remote units, shipboard, emergency disaster, etc.). The medical images received at the UWSoM over the ACTS are directly evaluated against the original digital images. The project demonstrates that a portable satellite-land connection can provide subspecialty consultation and education for rural and remote areas. The experiment is divided into three phases. Using the ACTS fixed-hopping beam, phase one involves testing connection of the AMT to medical imaging equipment and image transmission in various climates in western and eastern Washington state. The second phase involves satellite relay transmissions between the Inmarsat satellite and the ACTS/AMT through a ground station in Hawaii for medical imagery originating from either Okinawa, Japan or Kwajalein, in the Pacific. The third phase involves extended use of the ACTS steerable beam in Washington state, Idaho, Montanan and Oregon.

Diagnostic ultrasound and telemedicine utilization in the international space station

Clinical diagnostic ultrasound (US) is experiencing an expanding role that is well suited to application on the International Space Station (ISS). Diagnostic US can be used to reduce the risks associated with long duration human space flight by providing a non-invasive tool with head-to-toe diagnostic capability in both biomedical research and crew health care. General health care of the astronauts will be diagnosed with US, e.g., kidney stones, gall bladder disease, appendicitis, etc. Initial studies will focus on detection of “ureteral jets” in the bladder. This is a non-invasive test to rule out obstructive uropathy from kidney stones with minimal requirements for crew training. Biomedical research experiments, focusing on the effects of the microgravity environment, will be performed using both the HHU and the HDI 5000. US will be used to evaluate bone density and muscle mass in this environment. Prolonged or emergency EVAs may occur with the ISS. The hand-held ultrasound unit (HHU) and its telemedici...