Piezoelectric vibrating needle and catheter for enhancing ultrasound-guided peripheral nerve blocks.

Ultrasound imaging has been used for performing single-injection peripheral nerve blocks and continuous catheters. One limitation with current technology is the inability to confirm the location of the needle or catheter tip. We describe a new needle and catheter design that permits distal tip visualization using color flow Doppler. An 18-gauge 100-mm insulated Tuohy needle and a 20-gauge 50-mm polyamide catheter (open tip) with a Teflon-coated steel stylet (B. Braun, Bethlehem, PA) were customized by adhering in place two piezoelectric actuators. These created 1-8 kHz vibrations when coupled to a function generator (FG502, Tektronix, Richardson, TX) and a 100 W audio amplifier (R3000, KLH, Sun Valley, CA). Mimicking a lateral popliteal fossa block, the needle and catheter were inserted into the leg of an unembalmed cadaver. When activated, the tip of each was highlighted in color when scanned in the short axis using the color Doppler mode of a two-dimensional ultrasound and a 12 MHz L38 probe (MicroMaxx, Sonosite, Bothell, WA). Vibration technology may be a useful adjunct while performing ultrasound-guided regional anesthesia. Further study evaluating its usefulness and safety in live tissue is warranted.

Analysis of a vibrating interventional device to improve 3-D colormark tracking.

Ultrasound guidance of interventional devices during minimally invasive surgical procedures has been investigated by many researchers. Previously, we extended the methods used by the Colormark tracking system to several interventional devices using a real-time, three-dimensional (3-D) ultrasound system. These results showed that we needed to improve the efficiency and reliability of the tracking. In this paper, we describe an analytical model to predict the transverse vibrations along the length of an atrial septal puncture needle to enable design improvements of the tracking system. We assume the needle can be modeled as a hollow bar with a circular cross section with a fixed proximal end and a free distal end that is suspended vertically to ignore gravity effects. The initial results show an ability to predict the natural nodes and antinodes along the needle using the characteristic equation for free vibrations. Simulations show that applying a forcing function to the device at a natural antinode yields an order of magnitude larger vibration than when driving the device at a node. Pulsed wave spectral Doppler data was acquired along the distal portion of the needle in a water tank using a 2-D matrix array transesophageal echocardiography probe. This data was compared to simulations of forced vibrations from the model. These initial results suggest that the model is a good first order approximation of the vibrating device in a water tank. It is our belief that knowing the location of the natural nodes and antinodes will improve our ability to drive the device to ensure the vibrations at the proximal end will reach the tip of the device, which in turn should improve our ability to track the device in vivo.

Real-time, 3-D ultrasound with multiple transducer arrays.

Modifications were made to a commercial real-time, three-dimensional (3-D) ultrasound system for near simultaneous 3-D scanning with two matrix array transducers. As a first illustration, a transducer cable assembly was modified to incorporate two independent, 3-D intra-cardiac echo catheters, a 7 Fr (2.3 mm O.D.) side scanning catheter and a 14 Fr (4.7 mm O.D) forward viewing catheter with accessory port, each catheter using 85 channels operating at 5 MHz. For applications in treatment of atrial fibrillation, the goal is to place the sideviewing catheter within the coronary sinus to view the whole left atrium, including a pulmonary vein. Meanwhile, the forward-viewing catheter inserted within the left atrium is directed toward the ostium of a pulmonary vein for therapy using the integrated accessory port. Using preloaded, phasing data, the scanner switches between catheters automatically, at the push of a button, with a delay of about 1 second, so that the clinician can view the therapy catheter with the coronary sinus catheter and vice versa. Preliminary imaging studies in a tissue phantom and in vivo show that our system successfully guided the forward-viewing catheter toward a target while being imaged with the sideviewing catheter. The forward-viewing catheter then was activated to monitor the target while we mimicked therapy delivery. In the future, the system will switch between 3-D probes on a line-by-line basis and display both volumes simultaneously.

3-D ultrasound guidance of surgical robotics: a feasibility study.

Laparoscopic ultrasound has seen increased use as a surgical aide in general, gynecological, and urological procedures. The application of real-time, three-dimensional (RT3D) ultrasound to these laparoscopic procedures may increase information available to the surgeon and serve as an additional intraoperative guidance tool. The integration of RT3D with recent advances in robotic surgery also can increase automation and ease of use. In this study, a 1-cm diameter probe for RT3D has been used laparoscopically for in vivo imaging of a canine. The probe, which operates at 5 MHz, was used to image the spleen, liver, and gall bladder as well as to guide surgical instruments. Furthermore, the three-dimensional (3-D) measurement system of the volumetric scanner used with this probe was tested as a guidance mechanism for a robotic linear motion system in order to simulate the feasibility of RT3D/robotic surgery integration. Using images acquired with the 3-D laparoscopic ultrasound device, coordinates were acquired by the scanner and used to direct a robotically controlled needle toward desired in vitro targets as well as targets in a post-mortem canine. The rms error for these measurements was 1.34 mm using optical alignment and 0.76 mm using ultrasound alignment.

Real-time optoacoustic monitoring and three-dimensional mapping of a human arm vasculature.

We present our findings from a real-time laser optoacoustic imaging system (LOIS). The system utilizes a Q-switched Nd:YAG laser; a standard 128-channel ultrasonic linear array probe; custom electronics and custom software to collect, process, and display optoacoustic (OA) images at 10 Hz. We propose that this system be used during preoperative mapping of forearm vessels for hemodialysis treatment. To demonstrate the real-time imaging capabilities of the system, we show OA images of forearm vessels in a volunteer and compare our results to ultrasound images of the same region. Our OA images show blood vessels in high contrast. Manipulations with the probe enable us to locate and track arteries and veins of a forearm in real time. We also demonstrate the ability to combine a series of OA image slices into a volume for spatial representation of the vascular network. Finally, we use frame-by-frame analysis of the recorded OA video to measure dynamic changes of the crossection of the ulnar artery.

Measurement of the spectral directivity of optoacoustic and ultrasonic transducers with a laser ultrasonic source.

Comprehensive characterization of wideband ultrasonic transducers and specifically optoacoustic detectors is achieved through the analysis of their frequency response as a function of the incident angle. The tests are performed under well-defined, repeatable operating conditions. Backillumination of a blackened, acoustically matched planar surface with a short laser pulse creates an acoustic impulse which is used as a wideband ultrasonic source. Upon illumination with a short laser pulse, the bandwidth of our source shows a -6 dB point of 12 MHz and a low-frequency roll-off around 300 kHz. Using proprietary software, we examine thoroughly the planarity of the emitted wave front within a specified amplitude cutoff and phase incoherence. Analysis of the angular dependence of the frequency response yields invaluable directivity information about the detector under study: a necessary component toward accurate optoacoustic image reconstruction and quantitative tomography. The laser ultrasonic source we developed is the main feature of our directivity measurement setup. Due to its simplicity, it can easily be adapted to various calibration devices. This paper focuses on the development and characterization of the flatness and the bandwidth of our wideband ultrasonic source.

Vibrating interventional device detection using real-time 3-D color Doppler.

Ultrasound image guidance of interventional devices during minimally invasive surgery provides the clinician with improved soft tissue contrast while reducing ionizing radiation exposure. One problem with ultrasound image guidance is poor visualization of the device tip during the clinical procedure. We have described previously guidance of several interventional devices using a real-time 3-D (RT3-D) ultrasound system with 3-D color Doppler combined with the ColorMark technology. We then developed an analytical model for a vibrating needle to maximize the tip vibrations and improve the reliability and sensitivity of our technique. In this paper, we use the analytical model and improved radiofrequency (RF) and color Doppler filters to detect two different vibrating devices in water tank experiments as well as in an in vivo canine experiment. We performed water tank experiments with four different 3- D transducers: a 5 MHz transesophageal (TEE) probe, a 5 MHz transthoracic (TTE) probe, a 5 MHz intracardiac catheter (ICE) transducer, and a 2.5 MHz commercial TTE probe. Each transducer was used to scan an aortic graft suspended in the water tank. An atrial septal puncture needle and an endomyocardial biopsy forceps, each vibrating at 1.3 kHz, were inserted into the vascular graft and were tracked using 3-D color Doppler. Improved RF and wall filters increased the detected color Doppler sensitivity by 14 dB. In three simultaneous planes from the in vivo 3-D scan, we identified both the septal puncture needle and the biopsy forceps within the right atrium using the 2.5 MHz probe. A new display filter was used to suppress the unwanted flash artifact associated with physiological motion.

Autonomous surgical robotics using 3-D ultrasound guidance: feasibility study.

The goal of this study was to test the feasibility of using a real-time 3D (RT3D) ultrasound scanner with a transthoracic matrix array transducer probe to guide an autonomous surgical robot. Employing a fiducial alignment mark on the transducer to orient the robot's frame of reference and using simple thresholding algorithms to segment the 3D images, we tested the accuracy of using the scanner to automatically direct a robot arm that touched two needle tips together within a water tank. RMS measurement error was 3.8% or 1.58 mm for an average path length of 41 mm. Using these same techniques, the autonomous robot also performed simulated needle biopsies of a cyst-like lesion in a tissue phantom. This feasibility study shows the potential for 3D ultrasound guidance of an autonomous surgical robot for simple interventional tasks, including lesion biopsy and foreign body removal.

Real-time stereo 3D ultrasound.

Real-time 3D ultrasound was developed at Duke University in 1991 and has since been used with a variety of transducers and shown effectiveness in clinical applications and in vivo animal imaging studies. Methods for displaying the 3D pyramid of data acquired by the system include selecting 2D image slices or integrating data into a volume rendered view. A third method, real-time stereo 3D imaging, is discussed here. The clinical commercial 3D system has been modified in our laboratory to display a real-time stereo image pair on the scanner display to be viewed through a stereoscope. This merges the pair into a single image, with a sensation of depth. Stereoscopic displays have previously been demonstrated to provide benefits, including improved depth judgments and increased perception of image quality in other applications. Previously-saved volumes of ultrasound data are shown in stereo 3D using the new system.

Real-time 3D color flow Doppler for guidance of vibrating interventional devices.

The goal of this investigation was to examine the feasibility of guiding interventional devices using piezoelectric buzzers to create velocity sources, which were imaged and tracked with real-time 3D color flow Doppler. The interventional devices examined in this study included a pacemaker lead, Brockenbrough needle for cardiac septal puncture, cardiac guidewire and radiofrequency ablation needles for cancer therapy. Each was mechanically coupled to a piezoelectric buzzer and was imaged using a commercial real-time 3D ultrasound system with either a 2.5 MHz matrix array transducer or a 5 MHz, 22 F catheter transducer equipped with a tool port. In vitro images acquired in tissue phantoms, excised liver with a 'tumor' target and an excised sheep heart show strong vibration signals in 3D color flow Doppler, enabling real-time tracking and guidance of all the devices in three dimensions. In a sheep model, in vivo tracking of the pacing lead was performed in the superior vena cava as well as the right atrium using RT3D color flow Doppler images. The vibrating rf ablation needles were guided through the liver toward "tumor" targets in vivo with real-time 3D color flow Doppler images.