The Second Coming of Ultrasound


At the Sunnybrook Institute in Toronto, doctors have begun using focused ultrasound, delivered through helmet-like devices such as this, to loosen the blood-brain barrier, making it possible to deliver life-saving drugs.

Before Pierre Curie met the chemist Marie Sklodowska; before they married and she took his name; before he abandoned his physics work and moved into her laboratory on Rue Lhomond where they would discover the radioactive elements polonium and radium, Curie discovered something called piezoelectricity. Some materials, he found—like quartz and certain kinds of salts and ceramics—build up an electric charge when you squeeze them. Sure, it’s no nuclear power. But thanks to piezoelectricity, US troops could locate enemy submarinesduring World War I. Thousands of expectant parents could see their baby’s face for the first time. And one day soon, it may be how doctors cure disease.

Ultrasound, as you may have figured out by now, runs on piezoelectricity. Applying voltage to a piezoelectric crystal makes it vibrate, sending out a sound wave. When the echo that bounces back is converted into electrical signals, you get an image of, say, a fetus, or a submarine. But in the last few years, the lo-fi tech has reinvented itself in some weird new ways.

Researchers are fitting people’s heads with ultrasound-emitting helmets to treat tremors and Alzheimer’s. They’re using it to remotely activate cancer-fighting immune cells. Startups are designing swallowable capsules and ultrasonically vibrating enemas to shoot drugs into the bloodstream. One company is even using the shockwaves to heal wounds—stuff Curie never could have even imagined.

So how did this 100-year-old technology learn some new tricks? With the help of modern-day medical imaging, and lots and lots of bubbles.

Bubbles are what brought Tao Sun from Nanjing, China to California as an exchange student in 2011, and eventually to the Focused Ultrasound Lab at Brigham and Women’s Hospital and Harvard Medical School. The 27-year-old electrical engineering grad student studies a particular kind of bubble—the gas-filled microbubbles that technicians use to bump up contrast in grainy ultrasound images. Passing ultrasonic waves compress the bubbles’ gas cores, resulting in a stronger echo that pops out against tissue. “We’re starting to realize they can be much more versatile,” says Sun. “We can chemically design their shells to alter their physical properties, load them with tissue-seeking markers, even attach drugs to them.”

Nearly two decades ago, scientists discovered that those microbubbles could do something else: They could shake loose the blood-brain barrier. This impassable membrane is why neurological conditions like epilepsy, Alzheimer’s, and Parkinson’s are so hard to treat: 98 percent of drugs simply can’t get to the brain. But if you station a battalion of microbubbles at the barrier and hit them with a focused beam of ultrasound, the tiny orbs begin to oscillate. They grow and grow until they reach the critical size of 8 microns, and then, like some Grey Wizard magic, the blood-brain barrier opens—and for a few hours, any drugs that happen to be in the bloodstream can also slip in. Things like chemo drugs, or anti-seizure medications.

This is both super cool and not a little bit scary. Too much pressure and those bubbles can implode violently, irreversibly damaging the barrier.

That’s where Sun comes in. Last year he developed a device that could listen in on the bubbles and tell how stable they were. If he eavesdropped while playing with the ultrasound input, he could find a sweet spot where the barrier opens andthe bubbles don’t burst. In November, Sun’s team successfully tested the approach in rats and mice, publishing their results inProceedings in the National Academy of Sciences.

“In the longer term we want to make this into something that doesn’t require a super complicated device, something idiot-proof that can be used in any doctor’s office,” says Nathan McDannold, co-author on Sun’s paper and director of the Focused Ultrasound Lab. He discovered ultrasonic blood-brain barrier disruption, along with biomedical physicist Kullervo Hynynen, who is leading the world’s first clinical trial evaluating its usefulness for Alzheimer’s patients at the Sunnybrook Research Institute in Toronto. Current technology requires patients to don special ultrasound helmets and hop in an MRI machine, to ensure the sonic beams go to the right place. For the treatment to gain any widespread traction, it’ll have to become as portable as the ultrasound carts wheeled around hospitals today.

More recently, scientists have realized that the blood-brain barrier isn’t the only tissue that could benefit from ultrasound and microbubbles. The colon, for instance, is pretty terrible at absorbing the most common drugs for treating Crohn’s disease, ulcerative colitis, and other inflammatory bowel diseases. So they’re often delivered via enemas—which, inconveniently, need to be left in for hours.

But if you send ultrasound waves waves through the colon, you could shorten that process to minutes. In 2015, pioneering MIT engineer Robert Langer and then-PhD student Carl Schoellhammer showed that mice treated with mesalamine and one second of ultrasound every day for two weeks were cured of their colitis symptoms. The method also worked to deliver insulin, a far larger molecule, into pigs.

Since then, the duo has continued to develop the technology within a start-up called Suono Bio, which is supported by MIT’s tech accelerator, The Engine. The company intends to submit its tech for FDA approval in humans sometime later this year.

Instead of injecting manufactured microbubbles, Suono Bio uses ultrasound to make them in the wilds of the gut. They act like jets, propelling whatever is in the liquid into nearby tissues. In addition to its backdoor approach, Suono is also working on an ultrasound-emitting capsule that could work in the stomach for things like insulin, which is too fragile to be orally administered (hence all the needle sticks). But Schoellhammer says they have yet to find a limit on the kinds of molecules they can force into the bloodstream using ultrasound.

“We’ve done small molecules, we’ve done biologics, we’ve tried DNA, naked RNA, we’ve even tried Crispr,” he says. “As superficial as it may sound, it all just works.”

Earlier this year, Schoellhammer and his colleagues used ultrasound to deliver a scrap of RNA that was designed to silence production of a protein called tumor necrosis factor in mice with colitis. (And yes, this involved designing 20mm-long ultrasound wands to fit in their rectums). Seven days later, levels of the inflammatory protein had decreased sevenfold and symptoms had dissipated.

Now, without human data, it’s a little premature to say that ultrasound is a cure-all for the delivery problems facing gene therapies using Crispr and RNA silencing. But these early animal studies do offer some insights into how the tech might be used to treat genetic conditions in specific tissues.

Even more intriguing though, is the possibility of using ultrasound to remotely control genetically-engineered cells. That’s what new research led by Peter Yingxiao Wang, a bioengineer at UC San Diego, promises to do. The latest craze in oncology is designing the T-cells of your immune system to better target and kill cancer cells. But so far no one has found a way to go after solid tumors without having the T-cells also attack healthy tissue. Being able to turn on T-cells near a tumor but nowhere else would solve that.

Wang’s team took a big step in that direction last week, publishing a paper that showed how you could convert an ultrasonic signal into a genetic one. The secret? More microbubbles.

This time, they coupled the bubbles to proteins on the surface of a specially designed T-cell. Every time an ultrasonic wave passed by, the bubble would expand and shrink, opening and closing the protein, letting calcium ions flow into the cell. The calcium would eventually trigger the T-cell to make a set of genetically encoded receptors, directing it it to attack the tumor.

“Now we’re working on figuring out the detection piece,” says Wang. “Adding another receptor so that we’ll known when they’ve accumulated at the tumor site, then we’ll use ultrasound to turn them on.”

In his death, Pierre Curie was quickly eclipsed by Marie; she went on to win another Nobel, this time in chemistry. The discovery for which she had become so famous—radiation—would eventually take her life, though it would save the lives of so many cancer patients in the decades to follow. As ultrasound’s second act unfolds, perhaps her husband’s first great discovery will do the same.

Autism severity linked to genetics, ultrasound, data analysis finds.


For children with autism and a class of genetic disorders, exposure to diagnostic ultrasound in the first trimester of pregnancy is linked to increased autism severity, according to a new study.

Ultrasound diagnosis

For children with autism and a class of genetic disorders, exposure to diagnostic ultrasound in the first trimester of pregnancy is linked to increased autism severity, according to a study by researchers at UW Medicine, UW Bothell and Seattle Children’s Research Institute.

The study published Sept. 1 in Autism Research studied the variability of symptoms among kids with autism, not what causes autism. What they found is that exposure to diagnostic ultrasound in the first trimester is linked to increased autism symptom severity. The greatest link is among kids with certain genetic variations associated with autism; 7 percent of the children in the study had those variations.

FDA guidelines currently recommend that diagnostic ultrasound only be used for medical necessity.

“I believe the implications of our results are to bolster the FDA guidelines,” said corresponding author Pierre Mourad, a UW professor of neurological surgery in Seattle and of engineering & mathematics in Bothell who specializes in translational research on ultrasound and the brain.

Mourad said their results are about the first trimester of pregnancy. Data looking at the effect of ultrasound on the second and third trimester showed no link, he said.

The researchers used data from the Simons Simplex Collection autism genetic repository funded by the Simons Foundation Autism Research Initiative. The data was derived from 2,644 families among 12 research sites across the United States.

“There has been a real struggle in why there are so many kids with autism,” said lead author Sara Webb, UW Medicine researcher in psychiatry and behavioral sciences. “Where does this disorder develop from? How do kids get autism? And the second question is why are kids with autism so different from each other? This study really looks at the second question. Within kids with autism, what are some of the factors that may result in a child having a good outcome or higher IQ or better language or less severity versus a child who maybe takes more of a hit and continues to struggle throughout their lifespan?”

Webb said the research team approached their work based on a three-part model explaining variability in kids with autism. The first is a genetic vulnerability to the disorder. Second, is an outside stressor. And the third implies that the outside stressor has to impinge on a kid at a certain time.

Webb said a number of outside stressors have been proposed and investigated in autism. This study looked at only one of them — ultrasound.

As a mother of two, Webb said given what she knows now, she would not have ultrasound in the first trimester unless there is a medical necessity and that includes knowing how far along the pregnancy is.

“If we can figure out this information in any other way, I would go with that,” she said. “It’s always worth considering that when we do medical procedures, there are great benefits but also risk.”

Earlier study

In an earlier study, Mourad and co-authors Webb, Abbi McClintic (UW Medicine researcher in neurological surgery) and Bryan King, now a professor of psychiatry at the University of California, San Francisco, published a paper in Autism Research in 2014 that showed ultrasound exposure in-utero caused mice to exhibit autistic-like symptoms.

Mourad said he and King wanted to study the issue further. They brought together a team with a wide range of autism experience. King, formerly with UW Medicine, had conducted several clinical trials with children with autism. Webb works in developing biomarkers in kids with autism. Raphael Bernier, UW Medicine researcher in psychiatry and behavioral sciences, works with the Simon sample. Michelle Garrison, UW Medicine researcher with Seattle Children’s Research Institute specializes in statistics and epidemiology.

Mourad said he and his colleagues now intend to look more closely into links between ultrasound and autism severity, as well as the possibility — thus far not shown — that ultrasound exposure could contribute to autism incidence.

Ultrasound Opens the Brain to Promising Drugs


The protective sheath surrounding the brain’s blood supply—known as the blood-brain barrier—is a safeguard against nasty germs and toxins. But it also prevents existing drugs that could potentially be used to treat brain cancer or Alzheimer’s disease from reaching the brain. That’s why scientists want to unchain the gates of this barrier. Now a new study shows it’s been done in cancer patients.

The procedure works by first injecting microbubbles into the bloodstream and then using a device implanted near patients’ tumors to send ultrasonic soundwaves into the brain, exciting the bubbles. The physical pressure of the bubbles pushing on the cells temporarily opens the blood-brain barrier, letting an injected drug cross into the brain.

Alexandre Carpentier holds the SonoCloud device, which he has implanted in 15 brain cancer patients.

“People for years have been trying to open the blood-brain barrier,” said Neal Kassell, founder of theFocused Ultrasound Foundation. The device, called SonoCloud, was implanted and used on 15 patients during monthly chemotherapy with no ill effects after six months.

Although this is the first published study using ultrasound to open the blood-brain barrier in humans, it is not the first study to hit the news. In November, a team at the Sunnybrook Health Sciences Centre in Toronto announced the start of a clinical trial to open the blood-brain barrier using ultrasound in a single brain cancer patient. Carpentier’s trial, on the other hand, began in July 2014, and Kassell said the French study “is the first time they’ve shown the safety of repetitively opening the blood-brain barrier in humans.” Both clinical trials are ongoing.

The Sunnybrook trial used a focused ultrasound device, which is good for pinpointing localized cancers. In contrast, SonoCloud emits ultrasound more diffusely, which is useful for glioblastomas that blend into surrounding brain tissue. “It seems a little more aggressive to implant something,” Carpentier said, but the wider-ranging ultrasound opens a larger swath of the blood-brain barrier. This enables chemotherapy drugs to reach cancer cells around the periphery of the main tumor, hopefully reducing the chance that the cancer will grow back.

Magnetic resonance brain scans from one patient indicate that opening the blood-brain barrier with SonoCloud resulted in no further tumor progression.

Carpentier, who invented SonoCloud and founded its parent company, CarThera, says the most surprising part was the patients’ response to the implant. “The patients don’t feel anything when we emit ultrasound,” he says. “And they actually don’t complain about it. It was set up in the protocol to remove it after six months, but patients don’t want to remove it.”

He is now designing the next phase of the clinical trial to determine how much more effective the chemotherapy is with an opened blood-brain barrier. Carpentier says the technology is a “huge opportunity” to improve treatment of many diseases. He is also beginning work on a trial with Alzheimer’s patients, since studies in mice have showed that merely opening the blood-brain barrier with ultrasound helps remove the amyloid-β protein thought to be responsible for Alzheimer’s without using any drugs.

The ultimate goal of ultrasound therapy is “to be able to repetitively and reversibly open the blood-brain barrier in a non-invasive, targeted, and focused manner,” Kassell says. “This is one more step toward that goal.”

When it comes to detection, can ultrasound be mammography’s equal?


A study of more than 2,500 women has found ultrasound just as good as mammography at detecting breast cancer.

On the downside, ultrasound generated more false positives than mammography. However, the radiation-free modality also spotlighted more invasive and node-negative cancers—and the number of women recalled for additional testing post-ultrasound became comparable on incidence-screening rounds.

 - BreastMalig

The study’s authors, led by Wendie Berg, MD, of the University of Pittsburgh, conclude that their results suggest ultrasound could satisfactorily substitute for mammography in developing countries.

In the U.S., they state in their study discussion, ultrasound might supplement standard mammography for women with dense breasts who don’t meet high-risk criteria for screening MRI, as well as for high-risk women with dense breasts who balk at or refuse MRI.

The research team looked at 2,662 participants who were enrolled at 20 sites in the U.S., Canada and Argentina in the American College of Radiology Imaging Network  (ACRIN) 6666  trial and who completed three annual screens (7,473 exams) with ultrasound and film-screen (n = 4,351) or digital (n = 3,122) mammography and had biopsy or 12-month follow-up.

Noting cancer detection, recall and positive predictive values, they found:

  • 110 women had 111 breast cancer events; 89 (80.2 percent) were invasive cancers, median size 12mm.
  • The number of ultrasound screens to detect one cancer was 129, and for mammography the number of needed screens was 127.
  • Cancer detection was comparable for each of ultrasound and mammography at 58 of 111 (52.3 percent) vs. 59 of 111 (53.2 percent), with ultrasound-detected cancers more likely invasive (53 of 58, 91.4 percent, median size 12mm) vs. mammography at 41 of 59 (69.5 percent, median size 13mm).
  • Invasive cancers detected by ultrasound were more frequently node-negative, 34 of 53 (64.2 percent) vs. 18 of 41 (43.9 percent) on mammography.

Meanwhile, in 4,814 incidence screens in years two and three, ultrasound had higher recall and biopsy rates and a lower positive predictive value for biopsy than mammography.

“Training would be necessary for any facility planning to offer screening ultrasound, also true for developing countries,” Berg et al. write in their study discussion. “With appropriate training, ultrasound is no more operator dependent than interpreting mammography.”

The authors add that, while they previously showed in ACRIN 6666 that invasive lobular cancer and low-grade invasive ductal carcinoma are overrepresented among cancers seen only on ultrasound, they did not glean detailed molecular subtype results for the cancers in the present study.

Ultrasound prises open brain’s protective barrier for first time.


Ultrasound prises open brain’s protective barrier for first time.

Ultrasound prises open brain's protective barrier for first time
For the first time, the barrier that protects the brain has been opened without damaging it, to deliver chemotherapy drugs to a tumour.

The breakthrough could be used to treat pernicious brain diseases such as cancer, Parkinson’s and Alzheimer’s, by allowing drugs to pass into the brain.

The blood-brain barrier keeps toxins in the bloodstream away from the brain. It consists of a tightly packed layer of endothelial cells that wrap around every blood vessel throughout the brain. It prevents the passage of viruses, bacteria and other toxins, while ushering in vital molecules such as glucose via specialised transport mechanisms.

The downside of this is that the blood-brain barrier also blocks the vast majority of drugs. There are a few exceptions, but those drugs that are able to sneak through can also penetrate every cell in the body, which makes for major side effects.

Ultrasound prises open brain's protective barrier for first time

Now researchers at Sunnybrook Health Sciences Centre in Toronto, Canada, say they have successfully used ultrasound to temporarily open the blood-brain barrier, with the ultimate aim of treating a brain tumour. The procedure took place on 4 November.

Ultrasound prises open brain’s protective barrier for first time
The team, led by neurosurgeon Todd Mainprize and physicist Kullervo Hynynen, injected the chemotherapy drug doxorubicin along with tiny gas-filled microbubbles, into the blood of a patient with a brain tumour. The microbubbles and the drug spread throughout their body, including into the blood vessels that serve the brain.
Next the team applied focused ultrasound to the tumour and surrounding tissue via a cap full of transducers. The high-intensity ultrasound waves directed into the brain caused the microbubbles to vibrate.

The vibrating bubbles expanded and contracted about 200,000 times a second, forcing apart the endothelial cells that form the blood-brain barrier. The idea is that this would allow doxorubicin in the bloodstream to sneak through the gaps in the barrier and into nearby tumour cells.

The team confirmed that the blood-brain barrier had been breached by injecting a harmless contrast agent called gadolinium into the patient. Gadolinium cannot normally cross the barrier, says Mainprize. However, MRI scans clearly showed that the areas disrupted by the ultrasound contained gadolinium after the treatment, demonstrating that the blood-brain barrier had opened, he says.

A day later, the patient received traditional surgery to remove the tumour. The team will analyse the tissue to calculate how much of the drug reached its intended target. The patient is the first of 10 people who will receive the treatment, before the team publishes its results.

The team announced their breakthrough today at a virtual press conference.

“Opening the barrier is really of huge importance. It is probably the major limitation for innovative drug development for neurosciences,” said Bart De Strooper, co-director of the Leuven Institute for Neuroscience and Disease in Belgium, when the trial was launched.

Diagnosing Diastolic Heart Failure With Ultrasound: The FOAMed Report


Also, use of albumin in spontaneous bacterial peritonitis.

Calling all ultrasound guru wannabes: EM Curious gives an excellent overview on the diagnosis of diastolic heart failure using bedside ultrasound. And for even more practice, check out tips from the team at The Ultrasound Podcast.

You know how to treat hyperkalemia in your sleep. But did you know that dextrose lasts 1 hour? And the insulin you gave lasts 4 to 6? Get some quick pearls of wisdom on how to avoid the insulin-induced hypoglycemia that can occur up to 10% of the time during the management of hyperkalemia.

Speaking of ultrasound, did you know you can use it to confirm ETT placement? ALiEM shows us a novel, nifty technique to do so. And check outa recent systematic review and meta-analysis on use of ultrasound to confirm placement. Now if only we could get ultrasound to do our taxes for us …

Work through a great case of chest pain, bradycardia, and hypotension.

What is the evidence for levophed in septic shock? Here’s a great summary and podcast.

And finally, the evidence for albumin as a volume resuscitator in shock can be mixed at best. However, use of albumin in spontaneous bacterial peritonitis has been demonstrated to reduce mortality and renal impairment. Check out a summary of the evidence at the University of Washington’s EM Journal Club.

Scientists identify brain molecule that triggers schizophrenia-like behaviors, brain changes


Scientists at The Scripps Research Institute (TSRI) have identified a molecule in the brain that triggers schizophrenia-like behaviors, brain changes and global gene expression in an animal model. The research gives scientists new tools for someday preventing or treating psychiatric disorders such as schizophrenia, bipolar disorder and autism.

“This new model speaks to how schizophrenia could arise before birth and identifies possible novel drug targets,” said Jerold Chun, a professor and member of the Dorris Neuroscience Center at TSRI who was senior author of the new study.

The findings were published April 7, 2014, in the journal Translational Psychiatry.

What Causes Schizophrenia?

According to the World Health Organization, more than 21 million people worldwide suffer from schizophrenia, a severe psychiatric disorder that can cause delusions and hallucinations and lead to increased risk of suicide.

Although psychiatric disorders have a genetic component, it is known that environmental factors also contribute to disease risk. There is an especially strong link between psychiatric disorders and complications during gestation or birth, such as prenatal bleeding, low oxygen or malnutrition of the mother during pregnancy.

In the new study, the researchers studied one particular known risk factor: bleeding in the brain, called fetal cerebral hemorrhage, which can occur in utero and in premature babies and can be detected via ultrasound.

In particular, the researchers wanted to examine the role of a lipid called lysophosphatidic acid (LPA), which is produced during hemorrhaging. Previous studies had linked increased LPA signaling to alterations in architecture of the fetal brain and the initiation of hydrocephalus (an accumulation of brain fluid that distorts the brain). Both types of events can also increase the risk of psychiatric disorders.

“LPA may be the common factor,” said Beth Thomas, an associate professor at TSRI and co-author of the new study.

Mouse Models Show Symptoms

To test this theory, the research team designed an experiment to see if increased LPA signaling led to schizophrenia-like symptoms in animal models.

Hope Mirendil, an alumna of the TSRI graduate program and first author of the new study, spearheaded the effort to develop the first-ever animal model of fetal cerebral hemorrhage. In a clever experimental paradigm, fetal mice received an injection of a non-reactive saline solution, blood serum (which naturally contains LPA in addition to other molecules) or pure LPA.

The real litmus test to show if these symptoms were specific to psychiatric disorders, according to Mirendil, was “prepulse inhibition test,” which measures the “startle” response to loud noises. Most mice—and humans—startle when they hear a loud noise. However, if a softer noise (known as a prepulse) is played before the loud tone, mice and humans are “primed” and startle less at the second, louder noise. Yet mice and humans with symptoms of schizophrenia startle just as much at loud noises even with a prepulse, perhaps because they lack the ability to filter sensory information.

Indeed, the female mice injected with serum or LPA alone startled regardless of whether a prepulse was placed before the loud tone.

Next, the researchers analyzed brain changes, revealing schizophrenia-like changes in neurotransmitter-expressing cells. Global gene expression studies found that the LPA-treated mice shared many similar molecular markers as those found in humans with schizophrenia. To further test the role of LPA, the researchers used a molecule to block only LPA signaling in the brain.

This treatment prevented schizophrenia-like symptoms.

Implications for Human Health

This research provides new insights, but also new questions, into the developmental origins of psychiatric disorders.

For example, the researchers only saw symptoms in female mice. Could schizophrenia be triggered by different factors in men and women as well?

“Hopefully this animal model can be further explored to tease out potential differences in the pathological triggers that lead to disease symptoms in males versus females,” said Thomas.

In addition to Chun, Thomas and Mirendil, authors of the study, “LPA signaling initiates schizophrenia-like brain and behavioral changes in a mouse model of prenatal brain hemorrhage,” were Candy De Loera of TSRI; and Kinya Okada and Yuji Inomata of the Mitsubishi Tanabe Pharma Corporation.

Ultrasound offers gesture control.


The smartphone you control by gestures

Ultrasound technology that enables mobiles and tablets to be controlled by gesture could go into production as early as next year.

Norwegian start-up Elliptic Labs is in talks with Asian handset manufacturers to get the chip embedded in devices.

The technology works via an ultrasound chip that uses sound waves to interpret hand movements.

The move towards gesture control has gathered pace and there are now many such products on the market.

Big gestures

What sets Elliptic’s gesture-control system apart from others is its wide field of use, up to a metre away from the phone. It means it can identify mid-air gestures accurately.

Because it uses sound rather than sight, the sensor can recognise gestures from a 180-degree field. It also consumes less power and works in the dark.

By contrast Samsung’s Galaxy S4 uses an infrared sensor that can only interpret hand movements within a very small zone.

“The user needs to learn the exact spot to gesture to instead of having a large interactive space around the device,” said Erik Forsstrom, the user interface designer for Elliptic Labs.

The ultrasound system in action

Allowing users more freedom in how they gesture is vital if such products are to become mainstream, he thinks.

“With a small screen such as a phone or a tablet, the normal body language is not that precise. You need a large zone in which to gesture.”

If consumers can quickly see the effects their gestures have on screen, he thinks, “it is quite likely that this is the next step within mobile”.

The technology was recently shown off at Japanese tech show Ceatec.

In the demonstration, an Android smartphone was housed in a case containing the ultrasound transmitters.

But Elliptic Labs said it had formed partnerships with a number of Asian handset manufacturers who are looking at building the ultrasound chip into devices, as early as next year.

Mass market

“Start Quote

It is ideal if you have dirty or sweaty hands”

Ben Wood CCS Insight

Increasingly firms are experimenting with gesture control.

PrimeSense, the company that developed gesture control for Microsoft’s Kinect console, has also made strides towards bringing the technology to mobile.

By shrinking down the sensor used in the Kinect, the firm showed it working with a Nexus 10 at a Google developers‘ conference in May.

Meanwhile Disney is testing technology that allows users to “feel” the texture of objects on a flat touchscreen.

The technique involves sending tiny vibrations through the display that let people “feel” the shallow bumps, ridges and edges of an object.

Ben Wood, analyst with research firm CCS Insight thinks such devices could be ready for the mass market.

“Apple’s success has made gestures a part of everyday life. Now consumers understand they can manipulate a screen with a gesture or a swipe everyone is racing to find innovative ways to exploit this behaviour.

“Ultrasonic is particularly interesting as you don’t need to touch the screen which can be an almost magical experience.

“It is ideal if you have dirty or sweaty hands. A common example people use is flicking through a recipe when cooking. Other examples include transitioning through a slideshow of photos or flicking through music tracks or turning the page on an ebook,” he said.

“The big challenge that remains is how you make users aware of the capability.”

Ultrasound Confirms Tube Position During Cardiopulmonary Resuscitation.


In this small study, the positive predictive value of ultrasound to confirm endotracheal tube placement during active compressions was 98.8%.
Confirming correct endotracheal tube (ETT) placement during cardiopulmonary resuscitation (CPR) can be challenging. In a prospective observational study, researchers in Taiwan assessed the accuracy of real-time tracheal ultrasonography in 89 cardiac arrest patients (age range, 24–98 years) receiving emergency intubation during CPR. Patients with severe neck trauma, neck tumors, or history of neck surgery (including tracheotomy) were excluded. The gold standard for correct ETT placement was defined as bilateral auscultated breath sounds with good capnography waveform and exhaled carbon dioxide >4 mm Hg after at least 5 breaths.

Three senior emergency medicine residents supervised by experienced faculty performed tracheal ultrasonography during and immediately after ETT insertion, with most scans taking 10 seconds or less. Observation of a single air-mucosa interface with comet-tail artifact confirmed tracheal placement. Seven patients (7.8%) had esophageal intubations. Sensitivity, specificity, and positive and negative predictive values of tracheal ultrasound for identifying ETT position were 100%, 86%, 99%, and 100%, respectively.

COMMENT

Aspiration devices are the current standard for confirmation of tracheal tube placement during CPR when end-tidal CO2 is not detectable. Ultrasound shows promise in this setting, but the failure to identify 1 in 7 esophageal intubations is concerning. The key to establishing the value of ultrasound for tracheal tube confirmation lies in demonstration of its ability to detect 100% of esophageal intubations. We are not there yet.

Source: NEJM

MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study.


Background

Essential tremor is the most common movement disorder and is often refractory to medical treatment. Surgical therapies, using lesioning and deep brain stimulation in the thalamus, have been used to treat essential tremor that is disabling and resistant to medication. Although often effective, these treatments have risks associated with an open neurosurgical procedure. MR-guided focused ultrasound has been developed as a non-invasive means of generating precisely placed focal lesions. We examined its application to the management of essential tremor.

Methods

Our study was done in Toronto, Canada, between May, 2012, and January, 2013. Four patients with chronic and medication-resistant essential tremor were treated with MR-guided focused ultrasound to ablate tremor-mediating areas of the thalamus. Patients underwent tremor evaluation and neuroimaging at baseline and 1 month and 3 months after surgery. Outcome measures included tremor severity in the treated arm, as measured by the clinical rating scale for tremor, and treatment-related adverse events.

Findings

Patients showed immediate and sustained improvements in tremor in the dominant hand. Mean reduction in tremor score of the treated hand was 89·4% at 1 month and 81·3% at 3 months. This reduction was accompanied by functional benefits and improvements in writing and motor tasks. One patient had postoperative paraesthesias which persisted at 3 months. Another patient developed a deep vein thrombosis, potentially related to the length of the procedure.

Interpretation

MR-guided focused ultrasound might be a safe and effective approach to generation of focal intracranial lesions for the management of disabling, medication-resistant essential tremor. If larger trials validate the safety and ascertain the efficacy and durability of this new approach, it might change the way that patients with essential tremor and potentially other disorders are treated.

Source: Lancet