Category Archives: Basic Science and Instrumentation

Ultrasound: The Therapy of the Future Coming to a Clinic Near You!

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Ultrasound is most commonly known for diagnostic imaging and image-guided interventions, but there is also the potential to harness its power for therapeutic benefits. The use of ultrasound as a therapy is growing, with more than 1,900 active clinical investigations underway. There are also avenues to get insurance reimbursement for the treatment of certain ailments with ultrasound therapy, including bone metastases, essential tremor, and prostate.

In order to help guide physicians that may become involved in the use of ultrasound therapies, the Bioeffects Committee of the American Institute of Ultrasound in Medicine (AIUM) has issued new and updated statements on the AIUM website. These statements help to identify what to consider when using ultrasound therapies, including what happens to the targeted tissue and safety. Some highlights from these statements include:

  • Although safe when used properly for imaging, ultrasound can cause biological effects associated with therapeutic benefits when administered at sufficient exposure levels. Ultrasound therapeutic biological effects occur through two known mechanisms: thermal and mechanical. Thermal effects occur as the result of absorption of ultrasound waves within tissue, resulting in heating. Mechanical effects, such as fluid streaming and radiation force, are initiated by the transfer of energy/momentum from the incident pulse to tissue or nearby biofluids. Indirect mechanical effects can also occur through interaction of the ultrasound pulse with microbubbles such as ultrasound contrast agents. Importantly, thermal and mechanical mechanisms can trigger biological responses that result in desired therapeutic endpoints.
  • The type of bioeffects generated by ultrasound depend on many factors, including the ultrasound source, exposure conditions, presence of cavitation nuclei, and tissue type. Different bioeffects will require different amounts of ultrasound, and thermal and mechanical mechanisms can occur simultaneously for some exposure conditions.
  • There is the possibility of adverse effects in therapeutic ultrasound for targeted and untargeted tissue. Practitioners using these modalities must be well trained on the safe and effective use of therapeutic devices, knowledgeable about potential adverse events, aware of contraindications, and diligent in performing safe procedures. Image guidance should be used to ensure accurate targeting and dosing to maximize the outcomes for patients.

The statements issued by the AIUM’s Bioeffects Committee are intended as baseline considerations when a new therapy device is being put into practice. As ultrasound therapies continue to be adopted into clinical use, the Bioeffects Committee will continue to monitor outcomes in order to inform and educate the community.

Interested in learning more about the bioeffects of ultrasound? Check out the following Official Statements from the American Institute of Ultrasound in Medicine (AIUM):

Why Have UltraCon FOMO When You Can Be a Part of the Transformation of Medical Ultrasound?

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Are you still on the fence about deciding whether or not to attend UltraCon, a reimagined take on the American Institute of Ultrasound in Medicine’s annual meeting? The transformation of the AIUM’s annual ultrasound meeting into UltraCon is an exciting step forward for the field. It will provide a platform to connect professionals, share ideas, and learn from each other. 

Previously, we’ve highlighted the benefits of attending Day 1 and Day 2 of UltraCon, but what about Day 3? Just one look at the UltraCon schedule, and you can tell that this is going to be its busiest day yet! Despite the jam-packed program, there are a ton of amazing professional development opportunities ready for you to explore. On Tuesday, four new symposia will kick off, covering topics from 3D/4D imaging to musculoskeletal sonography. There’s also a shark tank competition, an e-poster kiosk hall, the annual AIUM Awards session, and don’t forget about the William J. Fry Memorial Lecture. 

Let’s dive into the first new symposia, Early Pregnancy Ultrasound: Implications and Impacts on Care. This TED-talk-style forum is a great resource for learning about critical issues in the first trimester, such as providing equitable care in the emergency department and managing life-threatening situations. It has not only valuable information for medical professionals but also provides important insight into how to support patients after Dobbs. Participants can earn up to 1.5 CMEs.

Next, we have Optimizing Outcomes in Prenatal Imaging. During this symposia, participants can increase the quality and patient experience in obstetric imaging with a multidisciplinary approach. A group of specialists will present TED talks on topics such as early trimester issues, health inequities, and maternal/fetal life-threatening situations. Improve imaging outcomes via a perception bias workshop, challenging cases, and using the 3D world to understand ultrasound. Plus, roundtables with industry on image optimization and a special session on understanding the lifecycle of prenatal imaging. Participants can earn up to 3.0 CMEs.

POCUS: Cutting-Edge Uses and Controversies is the third symposium of Day 3. Point-of-care ultrasound (POCUS) is revolutionizing the way clinicians diagnose and treat patients. By providing real-time insights, POCUS offers quick, accurate, and cost-effective diagnosis of clinical problems. From development to bedside, POCUS has changed the game for clinicians worldwide. Are you seeking an engaging and informative symposium to discuss current POCUS advancements in medical ultrasound? Look no further than POCUS: Cutting-Edge Uses and Controversies symposium, which discusses topics such as global health, first-trimester concerns, scan ownership, POCUS workflow, and more. With an array of activities, including lectures, panel discussions, and workshops, this is sure to be a stimulating symposium that will leave you informed and inspired.

Breaking the Sound Barrier: Shaping the Future of Ultrasound is the last symposium of the day. The highly interactive symposium on ultrasound technologies is a great opportunity for clinicians, technologists, researchers, industry, and other stakeholders to learn about the latest advancements in ultrasound technology. This symposium will provide an invaluable platform for experts to share their knowledge and insights on how to utilize ultrasound techniques in clinical settings effectively. Attendees will have a chance to interact with leading professionals from around the world and discuss potential solutions for existing challenges within this field.

Outside of attending the symposia, there are several other interactive activities for participants to engage in. Firstly, the AIUM supports an ePoster program every year where attendees can explore and learn at their own pace through self-guided exploration. Secondly, attendees who have a great ultrasound idea and want to pitch it to industry can submit an application to pitch their ideas to venture capitalists, leaders from the industry, and an IP attorney, for the chance to win a cash prize of $1,000. Lastly, don’t forget to attend the 2023 William J. Fry Lecture given by pioneer in gynecologic ultrasound, Dr. Steven R. Goldstein, entitled “Do You Do POCUS: Why reinvent the wheel?”.  

UltraCon will be the must-attend event of the year for medical professionals who want to stay up-to-date on the latest advancements in ultrasound technology. With a wide variety of engaging sessions and workshops, there’s something for everyone, so avoid getting caught with FOMO. All of this is just what is available on the third day of symposia at UltraCon. Check out the Full Schedule to start planning out your UltraCon journey.

Arian Tyler, BS, is the Digital Media and Communications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

Ultrasound: A Diagnostic Tool and for Treating Injuries and Diseases

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Now, more than ever, staying up to date on the latest trends and innovations in ultrasound is essential for physicians. This year, the annual meeting of the American Institute of Ultrasound in Medicine (AIUM) is being transformed into UltraCon! This new conference puts you at the center of the conversation where expertise meets interaction and debate. So how can you ensure that you are prepared to take full advantage of this transformative opportunity? 

In a previous post, we highlighted how you could explore new, exciting, and current technologies in ultrasound; identify the different approaches to diagnostic ultrasound; and determine which ultrasound techniques can help you advance your practice at “Can You Do That With Ultrasound?” on day one at UltraCon (March 25–29, 2023). Day two at UltraCon offers attendees more opportunities to deepen their understanding of ultrasound—both as a diagnostic tool and in treating injuries and diseases—through two additional symposiums: “Optimizing Ultrasound Image Quality” and “Ultrasound Diagnoses You Can’t Miss.”

Optimizing Ultrasound Image Quality

Optimizing ultrasound image quality and, ultimately, patient care is at the heart of this symposium. As a healthcare professional, you will be well-equipped to succeed at this task with knowledge gained through key topics such as physics, knobology, and Doppler, as well as improving patient/probe position. You will benefit from roundtable discussions that cover image reviews and quality assurance—useful topics that can help move one step closer to improving patient outcomes. Earn 5 CMEs for learning about ultrasound technology advancements, advancing your image acquisition techniques, and finding ways to improve image quality. This symposium is sure to contribute to providing better patient care!

This symposium will feature a total of 8 engaging and interactive sessions for attendees to participate through in groups:

  • “Physics: So Easy it Hertz,” led by Frederick Kremkau, PhD, FAIUM. How does ultrasound work? It’s all about physics. Knowing the role physics plays will help you avoid artifacts.
  • “Know Your Knobs,” led by Elena S. Sinkovskaya, MD, PhD. To even get an ultrasound image, you must know how your machine works, how to make fundamental adjustments, and how to make optimal use of B-mode. Glossary handout included.
  • “Elements of Scanning,” led by Margaret R. Lewis, MD. Improve your ultrasound diagnostics by understanding optimal patient and transducer positioning techniques, equipment quality assurance, and more.
  • “Demystifying Doppler,” led by Tracy Anton, MD. What is Doppler ultrasound? How does it work? How do I select the correct equipment? How do I interpret the results? Learn all this and more by attending.
  • “Just Images Roundtable,” led by Mishella Perez, BS, RDMS, RDCS, FAIUM, and Yvette S. Groszmann, MD, MPH. Learn what you can do to improve image quality across specialties, including OB, GYN, MSK, POCUS, and Vascular.
  • “Echoes of the Past to the Voices of the Future,” led by Frederick Kremkau, PhD, FAIUM. Attend this session to understand how prior advancements in ultrasound technology have established the scaffold for the possibilities of the use of diagnostic ultrasound in the present and the future.
  • “Ultrasound Quality Assurance Roundtable,” led by Timothy Canavan, MD, MSc, FAIUM, Therese Cooper, BS, RDMS, David Jones, MD, FAIUM, Anita Moon-Grady, MD, and Aubrey Rybyinski, MD. Understanding the role of accreditation and continuous QA is essential to ensuring the best outcomes for patients. Hear from a panel of experts to better guide your practice and get answers to your questions.
  • Image Quality Trivia: Test your ultrasound knowledge during this fun, quiz-style game where the entire audience participates. Topics include OB, fetal echo, GYN, physics, MSK, and general imaging.

Ultrasound Diagnoses You Can’t Miss

Ultrasound diagnoses are a crucial part of maintaining top-level medical care. Ultrasound experts from various disciplines meet in this symposium to share their expert knowledge and experience, allowing participants to stay on top of the imaging findings and avoid any form of misdiagnosis. During the symposium, a multispecialty expert panel will create an interactive discussion for the attendees to apply their learning to real clinical scenarios. And what’s more? You can earn up to 5.75 CMEs just by attending this “Ultrasound Diagnoses You Can’t Miss” symposium!

This symposium will feature a total of 17 engaging and interactive sessions for attendees to participate in where subspecialty discussion, breakout opportunities, and rapid case reviews will take place.

UltraCon is an incredible opportunity for medical ultrasound practitioners who want to stay up-to-date on all things related to medical ultrasound technology. From interactive debates to resource handouts, exhibitor sandboxes, and focus groups—this event has something for everyone! Come prepared with an open mind and get ready to connect with experts from around the world while learning about the exciting new possibilities that are transforming the field of medical ultrasound today! Don’t miss out—All of this is just what is available on the second day of symposia at UltraCon. Check out the Full Schedule to get a sneak peek at everything you could learn.

Arian Tyler, BS, is the Digital Media and Communications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

Where to Find What’s New in Ultrasound and Education

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As the use of ultrasound is expanding at a greater rate than ever, both as a diagnostic tool and in treating injuries and diseases, keeping up-to-date on all of the changes can be a struggle. In an upcoming symposium, however, you can explore new, exciting, and current technologies in ultrasound. Identify the different approaches to diagnostic ultrasound and determine which ultrasound techniques can help you advance your practice at “Can You Do That With Ultrasound?” on March 26, 2023, at UltraCon.

This symposium is an exciting new approach to discovering the technical advancement of ultrasound and applications across all subspecialties with collaborative interactions and networking opportunities to enhance the experience. It will begin with a discussion with John Pellerito, MD, Luis O. Tierradentro-Garcia, MD, Emile Redwood, MD, and John K. Hill of three abstracts with cutting-edge content regarding assessing cerebral blood flow in neonatal hydrocephalus, analyzing gene expression, and robotics-assisted transabdominal cerclage in pregnancy.

Next, with images and clinical histories, you will be able to review cases and discuss how each specialty group would approach the systems using different ultrasound techniques and instrumentation. Jon Jacobson, MD, Humberto Rosas, MD, Margarita Revzin, MD, MS, FSRU, FAIUM, Misty Blanchette Porter, and Stephanie Gisele Midgley, MD, will facilitate the discussion on state-of-the-art scanning techniques and innovative technology. Following that, John Pellerito, MD, will assist you with networking and crowdsourcing the answers to your questions. Then, industry representatives, expert clinicians, and expert researchers will also take questions.

Another symposium, “Everyone Can Be an Effective Ultrasound Educator” will also be happening that same day. Filled with practical and effective strategies and techniques to improve your teaching skills, Todd D. Zakrajsek, PhD, the keynote speaker, will share his thoughts on the foundational aspects of learning and relatively easy ways to teach while considering the diversity of learners today, as well as dispel learning myths and traps that hinder the learning process.

This symposium will feature a total of 8 engaging and interactive sessions for attendees to rotate through in groups:

  • “Active Learning, Learning by Doing,” led by Charlotte Henningsen, MS, RT(R), RDMS, RVT, FSDMS, FAIUM, Rebecca J. Etheridge, EdD, RDMS, and Sara Durfee, MD, will show you how to apply creative and meaningful activities designed to enhance the teaching and learning environment.
  • “Case-based Teaching: Let’s Have a Shared Learning Experience,” led by Iryna Struk, MS, RDMS, RDCS, RVT, and Jennifer Cotton, MD, will offer strategies for using case-based learning (CBL), an established approach used across disciplines where learners apply their knowledge to real-world scenarios, promoting higher levels of cognition.
  • “Good Job. Keep It Up. Effective and Ineffective Feedback Strategies in Ultrasound Education,” led by Creagh Boulger, MD, Lauren D. Branditz, MD, and Christine M. Schutzer, RT, BS, RDMS, will review the literature and techniques for effective feedback and assessment.
  • “Designing Virtual Lectures: A Necessary Challenge,” led by Kevin J. Haworth, PhD, Petra Duran Gehring, MD, RDMS, and Jacob Avila, MD, will review concepts in lecture design to increase student learning.
  • “Gaming: Trendy Buzz Word or Effective Educational Tool?” led by Creagh Boulger, MD, and Rachel Liu, MD, will be a hands-on activity to solve your needs in education and how you can apply gaming as an effective, evidenced-based strategy for assessment, learning, and engagement.
  • “Old School, New School, Best School,” led by Linda Zanin, Jennifer Cotton, MD, Lee Shryock, and Michelle Haines, will help you determine which new and exciting technologies are worth the investment and how you can integrate them into your curriculum.
  • “Social Media and Education,” led by Kevin J. Haworth, PhD, and Chris Fox, MD, discusses ways in which social media can be used to improve teaching and learning.
  • “The Impact of Emotional Intelligence in Education,” led by Charlotte Henningsen, MS, RT(R), RDMS, RVT, FSDMS, FAIUM, David Bahner, MD, and Hilary L. Davenport, DO, will provide tools that can help strengthen students’ emotional intelligence, which can positively impact relationships, academic success, and work performance.

In addition, this symposium includes “Learn From Our Learners,” in which former and current students (Creagh Boulger, MD, and Jennifer Cotton, MD) will share things that have worked well, experiences that have not worked well, and ideas they have for ways ultrasound can be better utilized in education.

All of this is just what is available on the first day of symposia at UltraCon. Check out the Full Schedule to get a sneak peek at everything you could learn.

Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

Can We Mix Some “Natural” Intelligence With the Artificial?

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As vascular surgeons involved with reading vascular ultrasound, we are no strangers to innovation in our clinical practice. Endovascular innovations have revolutionized this specialty and allowed our patients to recognize longer, more enjoyable lives as a result. I would say that as a specialty, vascular surgeons are generally embracing of new technology with the required amount of skepticism to ensure what we are doing actually helps our patients.

In recent years, there has been a boom in the use of artificial intelligence (AI) in many areas of practice. This includes surveillance of aneurysms, cannulation of vessels, as well as vascular ultrasound. Like many innovations, I think that as kinks get worked out the innovation and speed that AI brings will benefit our patients. I support the move forward.

However, we need some caution as we move forward. At our busy institution, we run our sonographers and radiologists off their feet with ultrasound studies of patients who have had increasingly complex open and endovascular treatments, often bilateral and often following other procedures. When my phone rings with one of our vascular radiologists on the phone, I can be assured of 3 things. The first is they are more than likely calling about one of the patients with a case similar to what I have mentioned above. The second assurance is that we will have a very fruitful conversation, while viewing pictures, about exactly what the sonographic findings are, what they mean for the patient, and how they may be worked up further, if necessary. I am also sure that I will engage with details of the procedure and the rationale for why it was done. This free-flow discussion will result in the third assurance, our patients will receive better care.

I am quite sure these conversations are happening all over the world. They bring two specialties together; they meld the art with the science, resulting in better patient care. My concern is that with the increasing use of AI, especially in the complicated cases, we will lose this connection and the ability to exchange information. We see this to some extent already; “In basket me!”, “text it over”, “check your email”. (Please don’t view this as an anti-technology rant, it really isn’t. Please view it as a pro-discussion rant!)

My concern is that the natural extension of AI use will be the elimination of experienced specialists who can engage in discourse about challenging problems and the specialists’ innate ability to leverage each other’s natural intelligence and experience. The very nature of widespread AI use in vascular ultrasound discounts this important exchange and actually rewards it for not occurring. It’s a system designed for speed and throughput, and its natural extension will be less conversation as the images are not passing the eyes of an experienced clinician but rather a microchip.

As I stated, I am not anti-technology, but I am pro-discussion! It behooves our specialties to celebrate this unique relationship we have had over decades. Call each other; support and explain things to each other. Be an example to others of true collaboration between “competitive” specialties. Embrace the technology as a means to showcase the true value of our different, yet complementary skills: excellent patient care. Besides, a cheerful phone call beats an “in-basket” any day.

Jonathan Cardella, MD, FRCS, is an Associate Professor of Surgery (Vascular) and Program Director of the Vascular Surgery residency at Yale School of Medicine.

Interested in reading more about the importance of communication? Check out these posts from the Scan:

From a Mental Image to Imaging Function in 3D

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I’m an engineer, and I work on developing ultrasound technology. When clinical colleagues describe how they use ultrasound to guide minimally invasive procedures, they will often reach a point in the explanation of the procedure when they say: “then I form a mental image of the anatomy.”

I recently attended a conference in Venice, Italy (the IEEE International Ultrasonics Symposium), where researchers have recently used sonar to map the ancient, now-submerged canal system of Venice, uncovering 2000-year-old roads. If we can traverse 2000-year-old Roman roads with sound, why can’t we do the same for minimally invasive procedures? How can we move beyond mental images to guide minimally invasive procedures with 3D images of both anatomy and functional information?

While more than 40 unique minimally invasive procedures are currently performed routinely, image guidance still relies heavily on forms of imaging that use ionizing radiation—for example, fluoroscopy or X-ray computed tomography (CT). For example, more than 1 million percutaneous coronary interventions are performed each year using fluoroscopy. 

If the technology that helps us explore underwater ruins or drive on the interstate could be integrated into the instruments that are inserted into the body during minimally invasive procedures, these procedures could then be performed without exposing the patient and staff to radiation. Catheters and guidewires could become devices to guide and monitor the procedure. With the right devices, ultrasound could perform several of these measurements, including 3D anatomical imaging, monitoring blood flow, stiffness, and perhaps even monitoring temperature or pressure. It’s easy to imagine a future in which interventions in cardiovascular diseases—the leading cause of death in the U.S.—are guided by ultrasound or other sensors integrated into the needles, guidewires, and in patches on the outside of the patient’s body.  

It’s an exciting time to work in ultrasound technology development because the spaces in which ultrasound can be applied are being stretched in ways that are not possible with other imaging modalities. However, it’s not quite as simple as adding all the sensors to existing devices. All fundamental physical limits on device performance in small spaces must be addressed. For example, an ultrasound transducer is several times less sensitive when sub-millimeter in size in comparison with transducers typically used for non-invasive imaging. Image quality and frame rates must be sufficiently high even with smaller devices.

Imagine if the catheter gives a 3D image of blood flow dynamics surrounding a stenosis, or the guidewire itself can image a chronic occlusion and allows the interventionalist to route the wire around it. Ultrasound-based monitoring patches on the outside of the patient’s body could be integrated with the sensors integrated into the instruments to provide a comprehensive view of the vitals and the instrument location. While imagination is required to envision the future we want, it would be better if we did not have to imagine the anatomy during the procedure. Partnerships between technology developers and clinical experts can enable a future with 3D ultrasound guidance of minimally invasive procedures.

Brooks Lindsey, PhD, is an Assistant Professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University.

Functional Transcranial Doppler Ultrasound

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“Hey Hannah – do you think there is much more to discover in ultrasound technology?” Hannah looked at me and…

It was about 30 years ago when I asked this question to a fellow graduate student while crossing the Duke quad. I was in the middle of a daunting doctoral program in ultrasound engineering—vanilla delay-and-sum beamforming had been the norm for many years, and we all knew speckle was a fundamental physics limitation. So what more could be done?

Perhaps it was the Carolina heat, or maybe I was addled from late-night calculations… but my, how short-sighted and naïve I was! Since that time, a host of new technologies and discoveries have proliferated within the ultrasound landscape, with many already making their way into the clinic. And of course, ultrasound has never lost its inherent competitive benefits of safety, mobility, and affordability. The future continues to look bright for our favorite imaging modality.

Today, I’d like to tell you about one of the more ‘niche’ ultrasound applications – functional transcranial Doppler ultrasound (fTCD). fTCD is an extension of transcranial Doppler ultrasound (TCD). Simply put, TCD is pulsed-wave Doppler of the basal cerebral arteries. Recently, a great clinical introduction to transcranial Doppler (TCD) was given on the Sonography Lounge.

The “functional” aspect of fTCD refers to monitoring changes in cerebral perfusion during neural activation by a functional task. These tasks could include motor, sensory, or cognitive stimuli. The fTCD response is based on neurovascular coupling – essentially, the link between neural activity and cerebral blood flow. Neurovascular coupling is something we don’t completely understand, but certainly something we can observe. One of the simplest (and most famous) examples is the increase in posterior cerebral artery blood flow velocity in response to a perceived visual change.

fTCD serves as a natural complement to other perfusion imaging modalities such as fMRI, PET, and fNIRS. The high temporal resolution (~100 Hz), anatomical target (deep branches off the circle of Willis), amenity to motion (robust during movement tasks), and safety couple well with the spatial and temporal extent and limits of these other modalities. Interestingly, because of these advantages, fTCD is being used in psychology and neuroscience research.

What medical information can fTCD results give us? Clinically, the change in cerebral blood flow might indicate hemispheric lateralization, help monitor intracranial pressure, show potential for stroke recovery due to somatosensory activation, and even predict preclinical Alzheimer’s disease – to name only a few! A wide range of clinical applications makes this easy-to-learn technique a tool with powerful potential.

By the way, how did Hannah (not her real name) answer my question? She just looked at me and laughed!

Greg Bashford, PhD, PE, is a Professor and Biomedical Engineer at the University of Nebraska.

Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community to share your experience.

Using AI and Ultrasound to Diagnose COVID-19 Faster

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Coronavirus disease 2019 (COVID-19) is a newly identified virus that has caused a recent outbreak of respiratory illnesses starting from an isolated event to a global pandemic. As of July 2020, there are over 2.8 million confirmed COVID-19 cases in the U.S. and over 11.4 million worldwide. In the United States alone, over 130,000 Americans have died from COVID-19, with no end in sight. A major cause of this rapid and seemingly endless expansion can be traced back to the inefficiency and shortage of testing kits that offer accurate results in a timely manner. The lack of optimized tools necessary for rapid mass testing produces a ripple effect that includes the health of your loved ones, jobs, education, and on the national level, a country’s Gross Domestic Product (GDP), but artificial intelligence and ultrasound may help.

STATE OF ART IN DIAGNOSIS

Prof. Alper Yilmaz, PhDCurrently, there are two types of tests that are conducted by healthcare professionals–diagnostic tests and antibody tests. The diagnostic test, as the name implies, helps diagnose an active coronavirus infection in a patient. The ideal diagnostic test and the “gold standard” according to the United States Center for Disease Control (CDC) is the Reverse Transcription Polymerase Chain Reaction, or simply, RT-PCR. RT-PCR is a molecular test not only capable of diagnosing an active coronavirus infection, but it can also indicate whether the patient has ever had COVID-19 or were infected with the coronavirus in the past. However, the time required to conduct the test limits its effectiveness when mass deployed.

A much faster but less reliable diagnostic test alternative to RT-PCR is an antigen test. Much like the gold standard, the antigen test is capable of detecting an active coronavirus infection in a much shorter timeframe. Although antigen tests produce rapid results, usually in about an hour, the results are deemed highly unreliable, especially with patients who were tested negative according to the US FDA.

In contrast, the antibody test is designed to search for antibodies produced by the immune system of a patient in response to the virus and is limited by its ability to only detect past infections, which is less than ideal to prevent an ongoing pandemic.

THE PROBLEM 

To combat the rapid expansion of an airborne virus such as COVID-19, or future variations of a similar virus, rapid and reliable solutions must be developed that aim at improving the limitations of current methods. Although highly accurate, methods such as RT-PCR do not meet the speed requirements needed for testing on a large scale. Depending on the location, diagnosis of an active coronavirus infection with RT-PCR may take anywhere between several hours and up to a week. When the number of daily human-to-human interactions are considered, the lack of speed in diagnosing an active coronavirus patient could be the difference between a pandemic or an isolated local event.

As an alternative to molecular tests, Computed Tomography (CT) scans of a patient’s chest have shown promising results in detecting an infection. However, in addition to not being recommended by the CDC to diagnose COVID-19 patients, there are many unwanted consequences with the use of CT scans. With CT scans used to diagnose multiple illnesses, some of which relate to serious emergencies such as brain hemorrhaging, they cannot be used as the primary tool for diagnosing COVID-19. This is especially true in rural areas where the healthcare infrastructure is underfunded. Mainly due to the required deep cleaning of the machine and room after each patient, which usually requires 60 to 120 minutes, many institutions are unable to provide CT scans as a viable primary diagnostic tool. Ultimately, given the need for CT scanners for several other health complications combined with limited patient capacity at each hospital, alternative methods must be developed to diagnose an active coronavirus patient.

THE SOLUTION 

Recently Point-of-Care (POC) devices have started to be adopted by many healthcare professionals due to its reliability and portability. An emerging popular technique, which adopts improvements made in mobile ultrasound technology, allows for healthcare professionals to conduct rapid screenings on a large scale.

Working since mid-March, when early cases of physicians adopting mobile ultrasound technology emerged, the research team at The Ohio State University, Dr. Alper Yilmaz and PhD student Shehan Perera, started developing a solution that can automate an already well-established process. Dr. Yilmaz is the director of the Photogrammetric Computer Vision lab at Ohio State. Dr. Yilmaz’s expertise in machine learning, artificial intelligence, and computer vision combined with the research experience of Shehan Perera laid a strong foundation to tackle the problem at hand. As it stands, the screening of a new patient, with the use of a mobile ultrasound device takes about 13 minutes, with the caveat that it requires a highly trained professional to interpret the results generated by the device. With the combination of deep learning and computer vision, the research team was able to use data generated from the ultrasound device to accurately identify COVID-19 cases. The current network architecture, which is the product of many iterations, is capable of detecting the presence of the virus in a patient with a high level of accuracy.

Many fields have been revolutionized with modern deep learning and computer vision technologies. With the methods developed by the research team, this technology can now allow any untrained worker to use a handheld ultrasound device, and still be able to provide a service that rivals that of a highly trained doctor. In addition to being extremely accurate, the automated detection and diagnosis process takes less than 10 minutes, which includes scanning time, and sanitation is as simple as removing a plastic seal that covers the device. The benefits of this technology can not only be useful for countries such as the United States, with a well-established healthcare system, but, more importantly, can significantly help countries and areas where medical expertise is rare.

CONCLUSION 

The United States healthcare system is among the best in the world, yet we are failing to provide the necessary treatment patients clearly need. The developments made in artificial intelligence, deep learning, and computer vision offer proven benefits, which can not only be leveraged to improve the current state of the global pandemic but can lay the foundation to prevent the next. Alternative testing methods such as mobile ultrasound devices combined with novel artificial intelligence algorithms that allow for mass production, distribution, and testing could be the innovation that could help decelerate the spread of the virus, reducing the strain on the global healthcare infrastructure.

Feel Free to Reach the Authors at: 

Photogrammetric Computer Vision Lab – https://pcvlab.engineering.osu.edu/
Dr. Alper Yilmaz, PhD
Email: Yilmaz.15@osu.du
LinkedIn: https://www.linkedin.com/in/alper-yilmaz

Shehan Perera
Email: Perera.27@osu.edu
LinkedIn: https://www.linkedin.com/in/shehanp/

References 

https://www.fda.gov/consumers/consumer-updates/coronavirus-testing-basics

https://www.whitehouse.gov/articles/depth-look-COVID-19s-early-effects-consumer-spending-gdp/#:~:text=BEA%20estimates%20that%20real%20GDP,first%20decline%20in%20six%20years.&text=This%20drop%20in%20GDP%20serves,in%20response%20to%20COVID%2D19.

 

Interested in learning more about COVID-19 or AI? Check out the following posts from the Scan:

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Pioneering Ultrasound Units

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If you think your ultrasound machine is out-dated, imagine if you still had to use these from as long ago as the 1940s. 

1940s

Ultrasonic Locator
Dr G. D. Ludwig, a pioneer in medical ultrasound, concentrated on the use of ultrasound to detect gallstones and other foreign bodies embedded in tissues. During his service at the Naval Medical Medical Research Institute in Bethesda, Maryland, Dr Ludwig developed this approach that is similar to the detection of flaws in metal. This is A-mode in its operation and was Dr Ludwig’s first ultrasonic scanning equipment.

Locator

 

1950s

Ultrasonic Cardioscope
Designed and built by the University of Colorado Experimental Unit, the Cardioscope was intended for cardiac work.

Ultrasonic Cardioscope

 

1960s

Sperry Reflectoscope Pulser / Receive Unit 10N
This is an example of the first instrument to use an electronic interval counter to make axial length measurements of the eye. Individual gates for the anterior segment, lens, and vitreous compartment provided accurate measurement at 10 and 15 MHz of the axial length of the eye. This concept was the forerunner of all optical axis measurements of the eye, which are required for calculation of the appropriate intraocular lens implant power after cataract extraction. This instrument, which includes A-mode and M-mode, was developed by Dr D. Jackson Coleman and Dr Benson Carlin at the Department of Ophthalmology, Columbia Presbyterian Medical Center.

Sperry Reflectoscope Pulser

 

Sonoray Model No. 12 Ultrasonic Animal Tester (Branson Instruments, Inc.)
This is an intensity-modulated B-mode unit designed exclusively for animal evaluations. The instrument is housed in a rugged aluminum case with a detachable cover that contains the cables and transducer during transportation. The movable transducer holder on a fixed-curve guide was a forerunner of mechanical B-scan ultrasonic equipment.

Sonoray Animal Tester

 

Smith-Kline Fetal Doptone
 In 1966, pharmaceutical manufacturer Smith Kline and French Laboratories of Philadelphia built and marketed a Doppler instrument called the Doptone, which was used to detect and monitor fetal blood flow and the heart rate. This instrument used the continuous wave Doppler prototype that was developed at the University of Washington. 

Smith Kline Fetal Doptone

 

Smith-Kline Ekoline 20
Working in collaboration with Branson Instruments of Stamford, Connecticut, Smith-Kline introduced the Ekoline 20, an A-mode and B-mode instrument for echoencephalography, in 1963. When B-mode was converted to M-mode in 1965, the Ekoline 20 became the dominant instrument for echocardiography as well as was the first instrument available for many start-up clinical diagnostic ultrasound laboratories. The A-mode was used in ophthalmology and neurology to determine brain midlines.

Ekoline 20

 

University of Colorado Experimental System
Developed by Douglas Howry and his team at the University of Colorado Medical Center, this compound immersion scanner included a large water-filled tank. The transducer moved back and forth along a 4-inch path while the carriage on which the transducer was mounted moved in a circle around the tank, producing secondary motion necessary for compound scanning. 

Compound immersion scannerCompound immersion scanner tub

 

1970s

Cromemco Z-2 Computer System (Bioengineering at the University of Washington)
This color-Doppler prototype, introduced in 1977, was the computer used for early color Doppler experiments. Z2 “microcomputers” were used for a variety of data acquisition and analysis applications, including planning combat missions for the United States Air Force and modeling braking profiles for the San Francisco Bay Area Rapid Transit (BART) system during actual operation.

Cromemco Z-2 Computer System

 

ADR-Model 2130
ADR of Tempe, Arizona, began delivering ultrasound components to major equipment manufacturers in 1973. Linear array real-time scanners, which began to be manufactured in the mid-1970s, provided greater resolution and more applications. Grayscale, with at least 10 shades of gray, allowed closely related soft tissues to be better differentiated. This 2-dimensional (2D) imaging machine was widely used in obstetrics and other internal medicine applications. It was marketed as an electronic linear array, which was faster and more repeatable without the need for a water bath as the transducer was placed right on the skin.

ADR Model 2130

 

Sonometrics Systems Inc, NY BR-400V
The first commercially available ophthalmic B-scanner, this system provided both linear and sector B-scans of the eye. The patient was examined in a water bath created around the eye by use of a sterile plastic ophthalmic drape with a central opening. Both A-scan and B-scan evaluations were possible with manual alignment of the transducer in the water bath. The instrument was developed at the Department of Ophthalmology, Columbia Presbyterian Medical Center by Dr D. Jackson Coleman, working with Frederic L. Lizzi and Louis Katz at the Riverside Research Institute.

Sonometrics Systems Inc, NY BR-400V

 

Unirad GZD Model 849
Unirad’s static B-scanner, allowing black-and-white anatomic imaging, was used with a scan arm and had similar controls as those used today, including processing, attenuation compensation, and gain.

Unirad GZD Model 849

 

1980s

American Flight Echocardiograph
This American Flight Echocardiograph (AFE) is a 43-pound off-the-shelf version of an ATL 400 medical ultrasonic imaging system, which was then modified for space shuttle compatibility by engineers at the Johnson Space Center to study the adaptations of the cardiovascular system in weightlessness. Its first journey to space was on the space shuttle Discovery in 1985 and its last on the Endeavour in 1992. The AFE generated a 2D cross-sectional image of the heart and other soft tissues and displayed it in video format at 30 frames per second. Below, Dr Fred Kremkau explains more about it.

 

To check out even more old ultrasound machines, visit the American Institute of Ultrasound in Medicine’s (AIUM’s) An Exhibit of Historical Ultrasound Equipment.

 

How old is the ultrasound machine you use now? What older ultrasound equipment have you used? Did it spark your desire to work with ultrasound? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

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The AIUM is a multi-disciplinary network of nearly 10,000 professionals who are committed to advancing the safe and effective use of ultrasound in medicine.

Physics of Ultrasound

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Snell’s Law [in-class demonstration]

The concept that sound reflects and propagates in varied angles is an abstract concept that many students struggle to understand. I review this concept by providing an in-class demonstration that makes this less abstract and something that can be seen with glasses of liquids.

Evans_Fig 1

 

If speed 1 < speed 2, then the incident angle < transmitted angle.

The difference in the stiffness and resulting propagation speeds helps to explain why the straw appears to be “broken” when you look through the side of the glass of water. The angle of transmission is measured against the vertical black line drawn on the glass of water. This helps to illustrate the 30-degree oblique incidence vs. the increased angle of transmission. A real-world example would be the change in imaging of a needle in a fluid-filled structure.

Example:

The propagation speed of sound through air is 900 m/sec while the propagation speed of sound through water is 1200 m/sec. To figure out the change in the angle of transmission, we form a ratio that will allow us to arrive at a percentage of change. So, 900/1200 = .75 and, therefore, that ratio of change from air to water in the glass is 100 – 75 = 25%. To figure out the angle, take 30 times .25 = 7.5 degrees. Therefore, 30 + 7.5 = 37.5 degree angle of transmission.

Now, consider a different glass of liquid as part of this demonstration by viewing a glass of Karo syrup.

Evans_Fig 2

This time, the glass is filled with Karo syrup, which is stiffer and denser than the water, and the transmitted angle is greater due to the increased ability to travel quickly in the second media.

 

If speed 1 < speed 2, then the incident angle < transmitted angle.

Example:

The propagation speed of sound through air is 900 m/sec while the propagation speed of sound through Karo is 1500 m/sec. To figure out the change in the angle of transmission, we form a ratio that will allow us to arrive at a percentage of change. So, 900/1500 = .60 and, therefore, the ratio of change from air to Karo syrup in the glass is 100 – 60 = 40% gain. To figure out the angle, take 30 times .4 = 12 degrees. 30 + 12 = 42 degree angle of transmission. The real world example for this is noting a speed propagation artifact.

A final demonstration can be a glass that has 1/3 air, 1/3 vinegar, and 1/3 cooking oil. Do not forget to add a straw so that several bends in the straw are noted by viewing through the side of the glass.

 

 

Kevin D. Evans, PhD, RT (R) (M) (BD), RDMS, RVS, FSDMS, FAIUM, is Chair and Professor of Radiologic Sciences and Respiratory Therapy at The Ohio State University in Columbus, OH.