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BMEG 4330 : Tele-medicine & Mobile Healthcare

Introduction to Sound and Light


Waves

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Sound Waves
Ultrasound frequencies
used in imaging are
typically 1-10 MHz

160 kHz =
0.16 MHz

http://www.sciencedirect.com/science/article/pii/S0378595512002778

BMEG 4330: Sound & Light Waves in Medicine

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Prepared by E. MacPherson

Uses of sound waves in medicine


Ultrasound imaging
imaging of internal organs
Image guided surgery
Monitoring fetal development
Blood flow (Doppler)

Ultrasound therapy
High-Intensity Focused Ultrasound (HIFU)
precise high-intensity focused sonic energy applied to locally
heat and destroy diseased or damaged tissue through
http://www.telegraph.co.uk/health/healthnews/9206425/New-treatment-forablation.
prostate-cancer-gives-perfect-results-for-nine-in-ten-men-research.html
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BMEG 4330: Sound & Light Waves in Medicine

Prof E MacPherson

Uses of sound waves contd


Lithotripsy
physical destruction of hardened masses like
kidney stones or gallstones.

Teeth cleaning

Physiotherapy
Increases blood flow

http://www.youtube.com/watch?v=BoZo08WSbsQ

Reduces swelling
Massages muscles, tendons, ligaments and
softens scar tissue
BMEG 4330: Sound & Light Waves in Medicine

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Light Waves

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BMEG 4330: Sound & Light Waves in Medicine

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Uses of Light waves in medicine


X ray imaging

Nuclear imaging (PET, SPECT)


Optical imaging

Terahertz imaging (in research)

http://lipas.uwasa.fi/~TAU/memos/AUTOaiv
o/Bslides.php?Mode=Printer

Photodynamic Therapy

Laser surgery
http://www.youtube.com/watch?v=GuT_XXyFPUI
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BMEG 4330: Sound & Light Waves in Medicine

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Schedule
Week
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Mon Wed
12:30- 15:3013:15 17:15
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Sept
Sept
Sept
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Nov
Nov
Nov
Nov/Dec
Dec

Introduction
Ultrasound-wave equation
Ultrasound-transmitivity and reflectivity
Ultrasound instrumentation
Ultrasound therapeutics and revision
Midterm test
THz introduction
terahertz imaging
terahertz spectroscopy, project briefing
U/S Demo
THz lab tour, Laser treatments and surgery
Photo dynamic therapy
Revision lecture
Project presentations

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BMEG 4330: Sound & Light Waves in Medicine

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BMEG 4330 : Tele-medicine & Mobile Healthcare

Ultrasound Imaging

http://www.nlm.nih.gov/medlineplus/ency/imagepages/18056.htm

Ultrasound wave theory


Imaging techniques and examples

What you probably know so far


Ultrasound waves are pressure waves
Ultrasound imaging does not usually
use higher frequencies than 10 MHz.

Ultrasound has a wavelength of about 1.5 mm.

Higher frequency ultrasound waves


can form sharper images
But higher frequency images are
fainter
Because higher frequency energy is absorbed
more strongly

http://www.youtube.com/watch?v=711bZ_pLusQ

BMEG 4330: Sound & Light Waves in Medicine

Pressure waves
Periodic motion causes pressure waves. In the
diagram a piston is attached to one end of a
spring. When the piston is shoved forward it
compresses one part of the spring. The
compression continues to travel through the
spring. As the piston moves back and forth, it
creates more compressions that travel down
the spring. The more quickly the piston moves
back and forth, the closer one compression is
to the next one.

http://www.physics247.com/physics-tutorial/ultrasound-physics.shtml

Prepared by E. MacPherson

The speed of Ultrasound


The speed of ultrasound does not depend on its
frequency
Speed depends on the material

Ultrasound travels faster in dense materials and slower


in compressible materials.
sound travels at around 1500 m/s in soft tissue, 3400 m/s in bone, and
330 m/s in air .

Ultrasound is reflected at the boundaries between


different materials.
Ultrasound reflects very well wherever soft tissue meets air, or soft
tissue meets bone, or where bone meets air.

Frequency is unchanged as sound travels through


various tissues.
This means that in tissues where sound travels more slowly, the
wavelength decreases. Traffic jam due to road works analogy.
http://www.physics247.com/physics-tutorial/ultrasound-physics.shtml

BMEG 4330: Sound & Light Waves in Medicine

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Ultrasound Generation

http://hopelifescan.com/physicsp2.htm
http://science.howstuffworks.com/ultrasound2.htm

BMEG 4330: Sound & Light Waves in Medicine

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Piezoelectric effect
Converts mechanical
energy into electrical
energy and vice-versa

http://www.pixelandlight.com/portfolio/animation.html

By applying pressure or mechanical stress on certain


natural non-symmetrical crystals an electric charge is
produced in direct proportion to the pressure.

If the same crystal is subjected to an electric field, the


crystals expand or contract in direct proportion to
the electric field.

http://www.everythingcarwash.com/customkraft.html

http://www.youtube.com/watch?v=OG6kI65PAaw
BMEG 4330: Sound & Light Waves in Medicine

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Probe design

The shape of the probe determines its


field of view

The frequency determines the depth of


penetration and resolution of the image.

Transducer probes may contain one or


more crystal elements

Beam steering

Requires multiple-element probes

important for cardiac ultrasound.

Impedance matching

http://www.olympus-ims.com/en/ndt-tutorials/transducers/pabeam/steering/

BMEG 4330: Sound & Light Waves in Medicine

in multiple-element probes, each crystal has its own circuit.

transducer face has a rubber coating. In addition, a waterbased gel is placed between the probe and the patient's
skin.

Echoes

The sound wave is partially reflected from the interface


between different tissues and returns to the transducer. This
returns an echo. Sound that is scattered by very small
structures also produces echoes.

Prepared by E. MacPherson

Image formation
Receiving the echoes
The return sound wave vibrates the transducer's elements and turns that
vibration into electrical pulses that are sent from the probe to ultrasound scanner
where they are processed and transformed into a digital image.

Forming the image


The ultrasound scanner must determine three things from each received
echo:
The direction of the echo.

How strong the echo was


white for a strong echo, black for a weak echo, and varying shades of grey for
everything in between

How long it took the echo to be received from when the sound was
transmitted.
Used to calculate depth information

From this information, the ultrasound scanner can locate which pixel
in the image to light up and to what intensity.
BMEG 4330: Sound & Light Waves in Medicine

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Echography
Using ultrasound echoes to image blood
flow and the heart

http://www.genesis.net.au
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Principles of Doppler Echocardiography


Doppler effect reminder??!

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BMEG 4330: Sound & Light Waves in Medicine

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Doppler shift from blood cells

For any given transmitted ultrasound frequency, the


returned frequency will be:
higher after encountering red blood cells moving toward the
transducer = POSITIVE Doppler shift; and
lower after encountering red cells moving away from the
transducer = NEGATIVE Doppler Shift

Doppler Shift = Frequency received by transducer Frequency transmitted by transducer


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Advantages of Ultrasound
Safe
Ultrasound imaging does not use ionizing radiation, non-invasive (no needles or
injections) and is usually painless.

Ultrasound causes no health problems and may be repeated as often as is


necessary.
Ultrasound is the preferred imaging modality for the diagnosis and monitoring of
pregnant women and their unborn infants.

Good for soft tissue imaging


gives a clear picture of that do not show up well on x-ray images.

Real-time imaging
a good tool for guiding minimally invasive procedures such as needle biopsies and
needle aspiration of fluid in joints or elsewhere.

Widely available, easy-to-use and less expensive than other imaging


methods.
BMEG 4330: Sound & Light Waves in Medicine

Prepared by E. MacPherson

Quantitative vs Qualitative
In previous BME courses ultrasound
imaging was mostly discussed qualitatively
The only calculations we made were for
Doppler echoe-ography

In BMEG 4330 we will be more


quantitative
we will look at the equations used to model
ultrasound wave propagation
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BMEG 4330: Sound & Light Waves in Medicine

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The wave equation


Acoustic waves are pressure waves
They propagate through matter via the compression
and expansion of the material
Generated by compressing a small volume of material
and then releasing it
The elastic properties cause the material to expand
beyond its equilibrium point and this causes
neighboring volumes to compress and thus the wave
propagates
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Sound is a longitudinal wave


Movement of particles is along the same direction as the direction of
wave propagation

http://www.youtube.com/watch?v=4iIE1Rm__-E

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BMEG 4330: Sound & Light Waves in Medicine

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Wave parameters

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BMEG 4330: Sound & Light Waves in Medicine

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Dependent variables
Acoustic waves also depend on space
(position x,y,z) and time (t)
Eg. A sudden bang dies away quickly
and can only be heard within a certain
distance from the source.

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BMEG 4330: Sound & Light Waves in Medicine

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Acoustic pressure
The compression and expansion of small
volumes causes a local change in the
materials pressure
An acoustic wave can be described by a
spatially dependent and time varying
pressure function p(x,y,z,t) called
acoustic pressure

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Acoustic pressure, p
For longitudinal waves: p = zv
z is characteristic impedance z = c
v is particle speed

Particle speed speed of sound


vc

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BMEG 4330: Sound & Light Waves in Medicine

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Table of acoustic properties

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The 3D Wave equation

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BMEG 4330: Sound & Light Waves in Medicine

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Plane waves

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BMEG 4330: Sound & Light Waves in Medicine

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General solution for plane waves

Forward wave

Backward wave

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Example

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BMEG 4330: Sound & Light Waves in Medicine

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Spherical waves

http://www.youtube.com/watch?v=Z43AfidDbQs

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General solution for spherical waves

Does not exist in practice


Outward
travelling
wave

Inward travelling
wave

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Example

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Acoustic Energy and Intensity


Acoustic waves carry energy
Kinetic Energy (from particles in motion)
Potential Energy (from particles poised for
motion)

For a wave we use energy density in


energy per unit volume
KE density = v2

PE density = p2
Total acoustic energy density = KE+PE
BMEG 4330: Sound & Light Waves in Medicine

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Acoustic intensity
Captures the idea of a change in energy
that moves with the wave
I = pv = p2/z (as v=p/z)
Analogy to circuits can you see it?!

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Reflection and refraction at plane


interfaces

Material 1

Material 2

i
Normal line

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BMEG 4330: Sound & Light Waves in Medicine

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Example
A plane ultrasound wave is incident at 45o
on an interface between the fat and liver of
a patient.
What is the angle of reflection?

What is the angle of transmission?

cfat = 1450m/s, cliver= 1570m/s


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BMEG 4330: Sound & Light Waves in Medicine

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Total internal reflection

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BMEG 4330: Sound & Light Waves in Medicine

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Transmission and reflection


coefficients at plane interfaces

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BMEG 4330: Sound & Light Waves in Medicine

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Derivation of the previous


coefficients
Uses the fact that velocity must be
continuous at the interface
And pressure is continuous

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Worked Example(s)

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Attenuation

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Phenomenological solution

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Nepers

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Frequency dependence of
absorption coefficient

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Coefficient a for different tissues

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Combining factors to calculate


reflection properties
Resulting reflected
amplitude is a product
of the reflection
coefficient and the
attenuation loss

BMEG 4330: Sound & Light Waves in Medicine

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Worked example

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Resolution

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BMEG 4330: Sound & Light Waves in Medicine

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Frequency vs penetration and


resolution
Higher frequency

Lower frequency

Shorter wavelength

Longer wavelength

More attenuation

less attenuation

Less penetration

greater penetration

Better axial and lateral


resolution

Lower axial and lateral


resolution

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BMEG 4330: Sound & Light Waves in Medicine

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Ultrasound instrumentation
How to control the frequency of ultrasound
generated
How the ultrasound beam is focused
How to steer the ultrasound beam

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Instrumentation
Most medical ultrasound systems use
the same transducer for generation and
receiving of ultrasound
pulse-echo mode

The transducer is coupled to the body


using an acoustic gel
The wave can then propagate to the
body to then be reflected off surfaces
and scatterers part of this signal is
returned to the transducer

The transducer converts the acoustic


wave sensed at its face into an electrical
signal
This can be stored, amplified and
displayed
BMEG 4330: Sound & Light Waves in Medicine

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The transducer
Uses piezoelectric crystals to
generate and receive U/S
eg. Lead zirconate titanate (PZT)
The crystals can be manufactured
in any shape
Most commonly rectangular or
circular

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Crystal properties
Transmitting constant, d, is the strain
produced by a unit electric field:
units m/V

Receiving constant, g, is the potential


produced by a unit stress:
units Vm/N or V/(N/m)
Material

d m/V

g V/(N/m)

PZT

300x10-12

2.5x10-2

Quartz

2.3x10-12

5.8x10-2

PVDF (PolyVinylidene 15x10-12


Fluoride)

14x10-2

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Resonance
Transducer crystals are resonant
http://www.youtube.com/watch?v=10lWpHyN0Ok

The resonant frequency fT depends on:


The thickness of the crystal, dT
The speed of sound in the crystal, cT

fT =
Hint. What is the effective wavelength for
constructive interference?
BMEG 4330: Sound & Light Waves in Medicine

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Question
What thickness of PZT crystal is needed to
make a transducer working at 10 MHz?
cT=8000m/s for PZT.

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Ultrasound transducer and output

A large voltage is applied to the crystal for a short


duration to excite (shock) the crystal into
resonance.

BMEG 4330: Sound & Light Waves in Medicine

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Ultrasound Imaging modes


A (amplitude)- Mode
Generates a one dimensional waveform (a point measurement so
not strictly an image). Can obtain detailed information about rapid or
subtle motion, eg of a heart valve

B (brightness)-Mode
Cross-sectional (2D) anatomical imaging (a line scan)

C (computed) -Mode
3D constructed image an array of B-Mode line scans

M-Mode
A succession of A-mode signals, brightness modulated and
displayed in time

Doppler
Uses the property of frequency or phase shift caused by moving
objects to generate images colour-coded by their motion
BMEG 4330: Sound & Light Waves in Medicine

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http://www.slideshare.net/vaseemali/ultrasound-instrumentation-physics

Good for:

Equipment usage

Time gain dispersion

BMEG 4330: Sound & Light Waves in Medicine

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Summary Video
http://www.youtube.com/watch?v=aYq9QSEBcCc
Good summary of u/s settings but quite slow!

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Beam pattern formation and focusing


The spatial distribution
of the acoustic intensity
is called the field
pattern

Near Field

Far Field

Simple field model


gives beamwidth, w(z):
w(z)=D, in the near field
w(z)=z/D in the far field

This approximation
ignores the waist in
the Fresnel region.
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Focusing
Most transducers are focused
to some extent
By making the transducer crystal
in a curved shape
By applying a lens to a flat
crystal
By electronic focusing of crystals
arranged in arrays

http://www.olympus-ims.com/en/ultrasonics/intro-to-pa/

A narrower beam gives better


spatial resolution

http://www.olympus-ims.com/en/ndt-tutorials/transducers/focusing/

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Mechanical scanning
For imaging the ultrasound beam must be steered
(scanned, swept)

This is done mechanically or electronically

Mechanical designs
a) Uses a rocking motion travels
in one direction then the other
b) Always goes in the same
direction, but switches in a new
transducer element
Note the field of view is always pieshaped.

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Electronic scanning
Transducers with multiple elements can be
electronically scanned to sweep the field of view.

Each element is rectangular and is focused in


the longer dimension using a lens
Two main arrangements:
Linear array probe
Phased array sector scanners
Nice summary here: http://www.bercli.net/documentation/article_principles.htm

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Phased array sector scanners


These next few slides
contain figures from the
course text book we will go
through the details on the
board bring paper!

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Transmitting pulses

BMEG 4330: Sound & Light Waves in Medicine

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Beam steering

http://www.olympus-ims.com/en/ndt-tutorials/transducers/pa-beam/steering/
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Question
A linear transducer array is operating in water (c=1484m/s). Adjacent
transducers are separated by d=0.8mm. A focal point at z=5cm on the
z axis is desired. If the outermost transducers fire at t=0, when does
the central transducer element fire?

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Receiving pulses

BMEG 4330: Sound & Light Waves in Medicine

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Time gain compensation


TGC
increasing amplification of echoes from
increasing tissue depths. Used in ultrasound
to correct for increased attenuation of sound
with tissue depth.

http://www.youtube.com/watch?v=t_721Q
wF9V8

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TGC

http://www.youtube.com/watch?v=t_721QwF9V8
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Summary video
Good overall summary video of how US
works
http://www.youtube.com/watch?v=t_721QwF9V8

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Therapeutic Ultrasound
Tissue stimulation

Fat reduction
HIFU and MRI guided HIFU

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Physiological effects of Ultrasound


Thermal effects of ultrasound
increased blood flow, reduction in muscle spasm, increased
extensibility of collagen fibres and a proinflammatory response.
It is estimated that thermal effects occur with elevation of tissue
temperature to 4045C for at least 5min
Excessive thermal effects, seen in particular with higher
ultrasound intensities, may damage the tissue
http://www.youtube.com/watc
h?v=fmFUwe7AqBQ

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Ultrasound therapy for babies


Ultrasound helps the neck muscle to heal

http://kidshealth.org/parent/medical/bones/torticollis.html

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Nonthermal effects of ultrasound


Cavitation and acoustic microstreaming,
more important in the treatment of soft tissue lesions than thermal
effects

Cavitation occurs when gasfilled bubbles expand and compress


because of ultrasonically induced pressure changes in tissue fluids,
with a resulting increase in flow in the surrounding fluid
Stable (regular) cavitation
beneficial to injured tissue, sustained at lower intensities

unstable (transient) cavitation


causes tissue damage, sustained at higher intensities

Acoustic microstreaming, is the unidirectional movement of fluids


along cell membranes,
occurs as a result of the mechanical pressure changes within the ultrasound field.
Microstreaming may alter cell membrane structure, function and permeability, which has
been suggested to stimulate tissue repair
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Cavitation example
http://www.youtube.com/watch?v=iceEuakmdNo

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Applications
Drug delivery
Delivering chemotherapy to brain cancer cells and various drugs to other tissues
is called acoustic targeted drug delivery (ATDD). These procedures generally
use high frequency ultrasound (1-10 MHz) and a range of intensities (0-20
watts/cm2).
The acoustic energy is focused on the tissue of interest to agitate its matrix and
make it more permeable for therapeutic drugs. (ATDD).
High intensities can disrupt the blood-brain barrier for drug delivery

Cleaning teeth in dental hygiene.


Low intensity pulsed ultrasound is used for therapeutic tooth and
bone regeneration.
Focused ultrasound sources may be used for cataract treatment by
phacoemulsification.

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Applications contd
Ultrasound-assisted lipectomy. Liposuction can also be assisted by
ultrasound.
http://www.youtube.com/watch?
v=544oDmiWq-E

Focused high-energy ultrasound pulses can be used in a process


known as lithotripsy to break calculi such as
kidney stones, gallstones, tumours, fibroids

Alternatively, ultrasound may be used for its thermal effects to


relieve pain and muscle spasm to increase tissue extensibility
Use in combination with stretching exercises to achieve optimal tissue length
Once the tissue has been heated to an adequate level (considered to be 40
45C), the opportunity to stretch the tissues lasts for up to 10min before the
tissue cools
BMEG 4330: Sound & Light Waves in Medicine

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Hi Intensity Focused Ultrasound (HIFU)


In this procedure, generally
lower frequencies than
medical diagnostic
ultrasound are used (250
2000 kHz), but significantly
higher time-averaged
intensities.

The treatment is often guided


by magnetic resonance
imaging (MRI)this is called
''Magnetic resonance-guided
focused ultrasound''
(MRgFUS).
Analogy to light
BMEG 4330: Sound & Light Waves in Medicine

http://www.youtube.com/watch?v=jrje73EyKag
http://www.youtube.com/watch?v=XFw7U7V1Hok
http://www.internationalhifu.com/what-is-hifu/how-itworks.html

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Wave focusing geometry for HIFU

http://bjr.birjournals.org/content/76/909/590.full

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MRI guided HIFU


ultrasound waves are focused into
a small area of between 416mm,
produces heat and energy, which kills
the tumor cells.

MRI guiding
localizes the area for ablation as well
as monitors the temperature.

Advantages over other treatments

http://www.youtube.com/watch?v=3FOy6YaTMPY

no surgery, no radiation, no scar, no


anesthesia, quicker recovery, more
precise image guided treatment and
less traumatic.
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HIFU for prostate cancer


Uses Ultrasound only during the procedure

http://www.youtube.com/
watch?v=EkDquVhW-rk

HIFU treats prostate cancer. It is a therapy that destroys tissue with rapid
heat elevation, which essentially "cooks" the tissue. Ultrasound energy, or
sound waves, is focused at a specific location and at that "focal point" the
temperature raises to 90 degrees Celsius in a matter of seconds.

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Summary
Ultrasound can be used at different
frequencies and powers for therapeutic
purposes
Thermal and non thermal effects can
change tissue properties to benefit the
patient
HIFU can be used for tumour ablation and
can be guided by MRI or ultrasound
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