Endoscopic ultrasound probes

A PMN-PT Composite-Based Circular Array for Endoscopic Ultrasonic Imaging

Endoscopic ultrasound (EUS), an interventional imaging technology, utilizes a circular array to delineate the cross-sectional morphology of internal organs through the gastrointestinal (GI) track. However, the performance of conventional EUS transducers has scope for improvement because of the ordinary piezoelectric parameters of Pb(Zr, Ti) [Formula: see text] (PZT) bulk ceramic as well as its inferior mechanical flexibility which can cause material cracks during the circular shaping process. To achieve both prominent imaging capabilities and high device reliability, a 128-element 6.8-MHz circular array transducer is developed using a Pb(Mg [Formula: see text]Nb [Formula: see text]) [Formula: see text]-PbTiO₃ (PMN-PT) 1-3 composite with a coefficient of high electromechanical coupling ( [Formula: see text]) and good mechanical flexibility. The characterization results exhibit a large average bandwidth of 58%, a high average sensitivity of 100 mV_pp, and a crosstalk of less than -37 dB near the center frequency. Imaging performance of the PMN-PT composite-based array transducer is evaluated by a wire phantom, an anechoic cyst phantom, and an ex-vivo swine intestine. This work demonstrates the superior performance of the crucial ultrasonic device based on an advanced PMN-PT composite material and may lead to the development of next-generation biomedical ultrasonic devices for clinical diagnosis and treatment.

Ultrasound-guided autologous blood injection in patients with chronic recurrent temporomandibular joint dislocation

Objective:

To evaluate the accuracy and effectiveness of ultrasound (US) guided autologous blood injection (ABI) for the treatment of chronic recurrent TMJ dislocation.

Design:

Prospective cohort study.

Setting:

Centre for medical education and research.

Participants (or Animals, Specimens, Cadavers):

Ninteen patients with chronic recurrent TMJ dislocation (Fifteen bilateral and fourteen unilateral).

Interventions:

Autologous blood injected, 2ml in superior joint space (SJS) and 1 ml in peri-capsular tissue (PT) under ultra sound guidance.

Main Outcome Measure(s):

Reduction in number of dislocation episodes, maximal mouth opening, pain (visual analogue scale) and TMJ sounds (present or absent) at the end of 2 weeks, 3 months, 6 months and 1 year.

Results:

At 2 weeks post operatively 18 patients (95%) were asymptomatic only one patient (5%) complained of Recurrence of dislocation and was treated successfully by a 2^nd injection. At subsequent follow up visits none reported dislocation.

Conclusion(s):

US guided ABI for patients with chronic recurrent TMJ dislocations serves as an alternative, minimally invasive, highly effective and accurate modality of treatment since it includes exposure without radiation, real-time visualization of soft tissues, visualization of the needle tip advancement, local anesthetic spread relevant to the surrounding structures which can be performed on an outpatient basis.

High Resolution Microultrasound (μUS) Investigation of the Gastrointestinal (GI) Tract

High resolution, microultrasound (μUS) scanning of the gastrointestinal (GI) tract has potential as an important transmural imaging modality to aid in diagnosis. Operating at higher frequencies than conventional clinical ultrasound instruments, μUS is capable of providing scanned images of the GI tract with higher resolution. To investigate the use of μUS for this application, a phantom which is cost effective, within ethical guidelines and, most importantly, similar in histology to the human GI tract is necessary. Therefore, a phantom utilizing porcine small bowel tissue has been developed for custom assembled μUS scanning systems. Two such systems, a stepping scanner and a continuous sweep scanner were utilized to repeatedly scan regions of prepared samples of porcine small bowel tissue. The porcine small bowel tissue phantom was perfused with degassed phosphate buffer saline (dPBS) solution through a cannula inserted in its mesenteric vessel to simulate in vivo conditions and achieve better μUS mucosal characterization. The μUS system scans a transducer across the tissue phantom to acquire RF echo data, which is then processed using MATLAB. A B-scan reconstruction produces 2D images with relative echo strength mapped to a color map of the user's choice. The phantom developed also allows for modifications such as the insertion of fiducial markers to detect tissue change over time and simultaneous perfusion and scanning, providing a platform for more detailed research and investigation into μUS scanning of the GI tract.

Miniprobe Endoscopic Sonography for Gastrointestinal Tract Assessment: A Case Series of 1451 Procedures

Conventional endoscopic sonography has allowed precise diagnostics without disturbances, and miniprobes can be easily introduced through the biopsy channel of the endoscope. Miniprobe endoscopic sonography has many benefits compared with conventional endoscopic sonography. Although there are well-known indications for miniprobe endoscopic sonography in endoscopic digestive tract assessment, there is still a need for this method to be widely spread among physicians and commonly used by most endoscopists. The aim of this series was to describe a multicenter retrospective experience with 1451 procedures using miniprobes, presenting examples and the applicability and usefulness of this technology in the daily activities of an endoscopy department.

Catheter-based high-frequency intraluminal ultrasound imaging is a powerful tool to study esophageal dysmotility patients

High-resolution manometry (HRM) is currently the most important diagnostic test for esophageal motility disorders, providing information on the contraction pattern of the circular muscle layer, which helps classify these esophageal motor diseases. However, with the increasing development of ultrasound, other techniques, such as high-frequency intraluminal ultrasound (HFIUS), have gained importance. This technique uses a flexible shaft with a central wire integrated into a standard endoscope, which facilitates real-time sonography. Its main utility is to provide anatomical information on the structure of the esophageal wall, including both the circular and longitudinal layers that constitute the esophageal muscularis propria. Increasing knowledge about these motility disorders has led to the hypothesis that, in addition to an abnormal contraction pattern of the circular muscle, an overall increased muscle thickness and an abnormal longitudinal muscle contraction could be added as pathophysiological factors. The increase in muscle thickness could be an important indicator of the severity of diseases, such as achalasia, distal esophageal spasm, or hypercontractile esophagus. More studies are required before definitive conclusions can be reached, but HFIUS employed simultaneously with HRM could provide a more complete and precise evaluation of these esophageal motor disorders.

High performance relaxor-based ferroelectric single crystals for ultrasonic transducer applications

Relaxor-based ferroelectric single crystals Pb(Mg_1/3Nb_2/3)O₃-PbTiO₃ (PMN-PT) have drawn much attention in the ferroelectric field because of their excellent piezoelectric properties and high electromechanical coupling coefficients (d₃₃∼2000 pC/N, kt∼60%) near the morphotropic phase boundary (MPB). Ternary Pb(In_1/2Nb_1/2)O₃-Pb(Mg_1/3Nb_2/3)O₃-PbTiO₃ (PIN-PMN-PT) single crystals also possess outstanding performance comparable with PMN-PT single crystals, but have higher phase transition temperatures (rhombohedral to tetragonal T_rt, and tetragonal to cubic T_c) and larger coercive field E_c. Therefore, these relaxor-based single crystals have been extensively employed for ultrasonic transducer applications. In this paper, an overview of our work and perspectives on using PMN-PT and PIN-PMN-PT single crystals for ultrasonic transducer applications is presented. Various types of single-element ultrasonic transducers, including endoscopic transducers, intravascular transducers, high-frequency and high-temperature transducers fabricated using the PMN-PT and PIN-PMN-PT crystals and their 2-2 and 1-3 composites are reported. Besides, the fabrication and characterization of the array transducers, such as phased array, cylindrical shaped linear array, high-temperature linear array, radial endoscopic array, and annular array, are also addressed.

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

BACKGROUND

Accurate preoperative staging is important in determining the appropriate treatment of gastric cancer. Recently, endoscopic ultrasound (EUS) has been introduced as a staging modality. However, reported test characteristics for EUS in gastric cancer vary. Our purpose in this study was to identify, synthesize, and evaluate findings from all articles on the performance of EUS in the preoperative staging of gastric cancer.

METHODS

Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 1 December 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. Meta-analysis for the performance of EUS was analyzed by calculating agreement (Kappa statistic), and pooled estimates of accuracy, sensitivity, and specificity for all EUS examinations, using histopathology as the reference standard. Subgroup analyses were also performed.

RESULTS

Twenty-two articles met our inclusion criteria and were included in the review. EUS pooled accuracy for T staging was 75% with a moderate Kappa (0.52). EUS was most accurate for T3 disease, followed by T4, T1, and T2. EUS pooled accuracy for N staging was 64%, sensitivity was 74%, and specificity was 80%. There was significant heterogeneity between the included studies. Subgroup analyses found that annual EUS volume was not associated with EUS T and N staging accuracy (P = 0.836, 0.99, respectively).

CONCLUSION

EUS is a moderately accurate technique that seems to describe advanced T stage (T3 and T4) better than N or less advanced T stage. Stratifying by EUS annual volume did not affect EUS performance in staging gastric cancer.