Thursday, December 29, 2011

Trans-Cranial Ultrasound Clot Buster

I have been speaking about this technology for years in the classroom.  Now it seems we have a commercial product with a CE endorsement that is evidence driven to be beneficial in the treatment of ischemic stroke (caused by a clot).  This technology uses ultrasound to vibrate a blood clot in the brain allowing better perfusion of clot busting drugs to break it up.  It has been used in research for years, but was very user intensive requiring the person aiming the probe to have extensive training in cranial anatomy.  This news is wonderful as ischemic strokes are a significant cause of death and disability around the world.  This technology cannot be used in hemorrhagic strokes though.  Happy New Year All!
REDMOND, Wash., Dec. 19, 2011 /PRNewswire/ -- Cerevast Therapeutics Inc., a privately held medical technology company, announced today that it has received CE mark clearance of its SonoLysis Headframe System, the Clotbust ER providing approval to commercialize the product in Europe.
The Clotbust ER is a first-in-class ultrasound device for the treatment of ischemic stroke, representing a novel product in an extremely high area of unmet medical need. Designed for rapid deployment in the emergency room setting, the device has been engineered to non-invasively deliver therapeutic ultrasound energy to the region of the occluded vessel in the brain as a treatment for ischemic stroke when used in combination with standard intravenous thrombolytic therapy (tissue plasminogen activator - tPA/Alteplase).

Sunday, November 13, 2011

Ultrasound and Evolution: a Personal retrospective ( Part 2)

I am sorry for being tardy in my next installment of this series.  Like many bad writers, we tend to think more than write.  I appreciate all who have commented on the blog.  I certainly like your comments.  Getting old is no fun, but I like to make it informative if nothing else.  To the left you see an invention that was something I looked at briefly when I was young.  I recall a machine invented in Australia.  I think the machine is called the Maytag Sonogram machine. 
News first:  FDA took back the warnings on the ultrasound contrast in the USA.  PLEASE contact the senator or congressman to urge the FDA to allow ultrasound contrast to be used in many other procedures.  Please link  

I linked a great author to this blog.  Pier Anthony Jacob (Pen name).  I hope he will tell me hello.  I arrived at the central airport in Denver in 1978, and fumbled around for my luggage, and retrieved them sans the Janet Nepalitono scrutiny.  Folk's, this is before the issues we face now.  Lets get back to the story.  My hospital bought a Unirad Machine.  Yep  (Johnson and Johnson).  Many of you know what we are talking about.  It was like Keith Emerson's Monster Moog.  OMG!  and here I am tryying to learn how to use it.
The speaker has no idea what an ultrasound is, yet his hair is perfect.  We all ask where a good lunch is.  He has no idea.
  I will never reveal the name of the speaker.  He might be a presidential adviser.  We all got on the Branniff airplanes and go home.  It happened folk's.  Stapleton International Airport, Hilton Hotel.  Let me know if you were there..  To Be continued.  Bless you all.

Tuesday, October 11, 2011

The International Contrast Ultrasound Society recently filed a petition with the FDA to remove the black box warning from ultrasound contrast agents used in the USA.  These IV medications have been proven time after time to be safe and effective, yet the FDA is persistent with its invalid warnings.  I am a member of the ICUS, and I support the move, and hope the FDA will consider this petition, as well as consider allowing use of IV ultrasound contrast agents in other areas of diagnostic ultrasound like many other nations.  

CHICAGO, Oct 03, 2011 (BUSINESS WIRE) -- Cross-specialty international medical experts filed a Citizen Petition with the FDA today, asking the agency to remove boxed warnings from ultrasound contrast agents, stating that the warnings deter use of a safe, inexpensive and radiation-free diagnostic imaging tool with potential life-saving benefits for patients. 


Tuesday, August 2, 2011

Ultrasound and Evolution: A personal retrospective (Part 1)

I started life as a Medical Radiographer.  I graduated in the late 70's with a degree in radiologic health science, and proceeded to go to work in the hospital where I trained, a 320 bed hospital in north Texas.  Back in the 70's it was hard on people who were sick.  Going to X-Ray was a trip to the torture chamber some patients would recall.  Pain in the tummy?  Well, let's see:  We can give you an oral cholecystogram, and IVP, a barium enema, and an upper-GI to start with.  Headache?  We can really make your day with a pneumoencephalogram (a procedure whereby we insert a needle into the neural tube in your back, then inject room air to see how it behaves in the ventricles of the brain).  These patients would scream in pain due to the pressure of the air in their head.  If these examinations failed to find the problem the surgeon would wander into the room and confess that it was time to perform a diagnostic laparotomy (belly cases) or another surgical procedure.  For those of you reading this, be patient.  What I am relating to you are my personal experiences starting from over 30 years ago.  Call this a personal retrospective.

When I went to work F/T at the hospital, I was trained to perform special procedures.  Angiography before digital imaging involved something called "film". We were trained to load and process film in a dark room.  The angiogram was performed by exposing several sheets of film loaded into a film changer to x-rays.  In the cases of a cerebral angiogram, films were bi-plane.  In other words, the films were rapidly taken from two perspectives:  AP and medio-lateral. I usually scrubbed in and assisted the radiologist with the surgical portion of guiding a catheter into an artery in the brain, then injecting meglumine (Conray or Reno-76).  The surgical procedure has not changed much over the years, with the exception that I no longer give valium and demerol to the patient to control pain and anxiety.  This is now handled by an RN or anesthesiologist  Yes, you read correctly.  Part of my job was to administer medications to the patient during the procedure (though I was poorly trained to do this part).  Scope of practice for many health care professionals were poorly defined at this time.

The late 70's were a period of Renaissance in medical imaging. I am fortunate to have been fresh out of school when the CAT scanner and B-scanner ultrasound machines were being purchased by the progressive hospitals of the day.  Radiologists who were never trained in cross sectional anatomy were pulling their hair out trying to correlate what was shown on the CT and what anatomy they were seeing.  Ultrasound was even worse on the Radiologist.  One guy I worked for compared ultrasound to looking at post modern art made by elephants with  buckets of black paint and brushes in their trunks.

It all changed for me one day when the administrator of the hospital asked me to accompany him to a storage room in the bowels of the hospital.  We opened a huge wooden crate and inside there was a contraption that could have been the Doppelganger of Keith Emerson's Monster Moog music synthesizer.  As I was a keyboard musician I excitedly asked the administrator if this was a musical instrument.  He replied that it was a sound wave machine for medical purposes and the chief of staff had asked him to purchase it for the X-ray department.  He continued by asking me if I was interested in attending a three day seminar on the use of the instrument (Unirad B scanner Johnson and Johnson Corporation). He offered me my own department if I succeeded.  Since I was young and energetic I agreed (Knowing full well that an 18 year old new X-Ray graduate with his own department in a large hospital with a nursing program may very well become a chick magnet).

I was off to Denver on a mission!

To Be Continued...

Plants Attract Bats With Physics

Examples of physics abound in the natural world.  Many animals and plants utilize the natural laws of our universe to live, reproduce, and obtain food.  It has been known for many years that bats use high frequency sound waves to echo-locate insects on nightly forays in search of food.  What has recently been discovered is a plant that actively encourages bats to drink nectar from it's fruit, and spread pollen in the process by forming echo-genic leaves designed to allow bats an easier time in finding the fruiting portions of the plant.  Isn't life marvelous?

Most plants are pollinated through bees, but one plant, Marcgravia evenia, which grows in the Cuban rainforest, has it a little harder: it has to attract on-the-go bats in the dark of night.
Instead of using their eyes, the flying mammals orient themselves with echolocation: they send out ultrasound waves and listen closely to which sounds echo back.
According to a study published Friday in the journal Science, a team of British, German and Canadian researchers have shown that this newly-discovered plant that has evolved to reflect back especially audible ultrasound waves. Marcgravia evenia achieves this through concave, spherically shaped leaves.,,15276492,00.html

Friday, June 17, 2011

Ultrasound Replaces CT As First Choice

As many of you know I am very much a supporter of ultrasound being the first medical imaging modality utilized when a patient needs medical imaging to establish a diagnosis.  I am on the record as saying medical ultrasound is a great way to start out when a patient presents with symptoms of appendicitis.  As an example, ultrasound is not used to R/O the disease, it is used to "rule in" appendicitis.  The reason is two fold: 1) a CT scan is expensive 2) A CT scan involves ionizing radiation.  Many people are realizing these issues.  Here is part of an article I saw online addressing  this topic.

OREM, UT, June 02, 2011 /24-7PressRelease/ -- Just as insurance carriers are scrutinizing the higher cost of a CT scan versus that of an ultrasound for diagnostic screenings, patients are becoming aware of and concerned about the amount of radiation delivered by a CT scan. This is leading to an increased number of ultrasounds being performed in several medical situations.

Tuesday, June 14, 2011

Hospital Medicine Probes The Use of Ultrasound

A doctor who treats only patients admitted to a hospital is often referred to as a "hospitalist".  I have met a few of these versatile doctors in my job as an ultrasound instructor.  These doctors are charged with dealing with the problems that flare up like wild fires when other physicians are home in bed.  They are trained to deal with many issues, and they are trained to know their limits.  Many of these issues occur in the ICU or CCU and are cardiac, or surgically related.  It is natural for them to be creative with patient care, because they are often working alone without the help of other physicians.  Naturally, hospitalists are discovering the wonderful tool called portable ultrasound.  It makes perfect sense when trying to insert a line in the internal jugular to use ultrasound as a guide.  What about post surgical bleeding? Piece of cake.  Cardiac issues?  Pull out the cardiac probe to scan for a pericardial effusion.  My job is to train the wonderful doctors and give the tools and expertise at making a rapid and accurate diagnosis with portable ultrasound. 

“The ultrasound will be the stethoscope of the 21st century,” says Mark Ault, director of the Division of General Internal Medicine and assistant chairman for clinical affairs of the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles. “And the goal will be to have an ultrasound in the hands of every internist.”

Tuesday, June 7, 2011

NASA And Ultrasound

The machine you see to the left is a Philips 5000 modular ultrasound machine which is installed in the ISS. I have good friends that work at Johnson Space Center in Houston and many are physicians.  One of the benefits of the ISS is the medical research that is performed there by the astronauts.  One of the most useful technologies they use is the ultrasound machine.  They study everything from optic nerve diameters to diastolic function of the heart in the weightless environment.  As the medical director of the ISS once said to me: "One of the biggest challenges to the space program is keeping people alive and well in the hostile environment of outer space".  The machine pictured to the left recently died, and a smaller replacement ultrasound machine will be sent up to replace it.

A recent article on Space on shows astronaut Leroy Chiao performing an eye examination onboard the International Space Station. The exam was performed on Salizhan Sharipov, a cosmonaut who took advantage of NASA’s ultrasound-based “all purpose diagnostic machine”. This ultrasound machine is unique, in that it is directly linked from the Space Station to doctors on Earth. Why use ultrasound machines in space? Like most of the other space-bound experiments, it has a practical application.

Thursday, June 2, 2011

Diastolic CHF

Cardiologists have known for years that a patient may have a systolic ejection of over 55 percent and normal wall motion but still suffer from congestive heart failure.  Yes you heard me right.  Diastolic heart failure is a real entity, and it is not taken seriously by all medical professionals.  Recently, many papers have been published stressing the importance of treating diastolic dysfunction with medications, diet and exercise.  The long term effects of diastolic heart disease are devastating frequently leading up to chronic illnesses that are a challenge to treat from both a medical and an economical standpoint.

If that link does not work try this one:


Monday, May 2, 2011

Ultrasound and CT Re-Visited

Ultrasound is a logical choice to use when evaluating a patient for suspected appendicitis because it is economical, and does not utilize radiation.  Ultrasound is used to rule in appendicitis, not rule it out.  This concept is very important especially when dealing with children.  The thinking is that we would like to utilize everything possible in the evaluation that does not use radiation.  America has traditionally been too quick to send patients to the CT scanner.  It is a simple matter for the trained Sonographer or Physician to "take a look" with ultrasound.  We need to revisit these concepts.

April 18, 2011 -- NEW YORK CITY - Partially substituting ultrasound for CT in evaluating appendicitis could save the U.S. healthcare system more than $1 billion, according to research presented Saturday at the American Institute of Ultrasound in Medicine (AIUM) annual meeting.
While ultrasound has high positive predictive value for appendicitis and provides low cost and no radiation exposure, the modality appears underutilized in this application, according to Dr. Levon Nazarian. He presented the research findings on behalf of lead author Laurence Parker, PhD.

Here is the link to the article through Auntminnie: 

Thursday, April 21, 2011

Ultrasound or CT for Testicular Imaging

I came across an interesting article regarding CT being used to watch for the spread of testicular cancer in patients electing not to have an orchiectomy for an early lesion.  These patients were either older, or men who feared the side effects of orchiectomy such as impotence.  It seems since the early 1980s CT has been the method of choice for checking to see if the retroperitoneal lymph nodes become involved.  The article further goes on to discuss the secondary cancers associated with this form of surveillance. I would think ultrasound would be a less hazardous approach in this regard.  But I am only a Sonographer.

"In the 1990s, nearly half of patients diagnosed with early-stage disease were treated with orchiectomy (testicle removal) alone. For those patients, the US National Comprehensive Cancer Network Guidelines recommend a total of 15 CT scans in the first five years after surgery (every two to three months for the first year, then tapering off each consecutive year) to check for new signs of disease. After four years, CT scans are recommended just once annually.

Excessive CT scanning has been the topic of considerable debate in recent years; as the technology has become better at detecting disease, it has been used with far more frequency, exposing more people to ionizing radiation, which can cause cancer at high doses. “What has happened is that because CT images are so diagnostically useful, physicians request them for their patients in great numbers, so the concerns are really based upon the fact that 80 million CT scans are performed every year in the US,” said Dr. Boone. “That is a huge number.” 

Here is the link:

Wednesday, March 16, 2011

High Intensity Focused Ultrasound Breakthrough

The following link describes a new procedure where HIFU is used to treat essential tremor.  I will watch developments in this area with interest since it may herald a new way to treat other brain diseases.

A new chapter in medical history opened days ago when noninvasive MR-guided focused ultrasound was used to successfully treat a patient with essential tremor (ET), a progressive neurological disorder that affects millions of people worldwide and causes involuntary shaking of the hands, head, face, eyelids, voice or other muscles.

Wednesday, January 26, 2011

New Treatment For Pulmonary Embolism

A new treatment for PE's is causing a stir in the medical community.  It seems a catheter system that injects medication while stimulating a clot with ultrasound waves has proven very effective in treating this potentially life threatening condition.

In traditional therapy, thrombolytic drugs are delivered to the blockage, but the method can take many hours or even days. In the ultrasound method, the device (EkoSonic System, Ekos) is advanced through the femoral artery to the clot, where it emits sound waves that loosen the clot, allowing the thrombolytic drugs to dissolve it faster. The system has received a CE mark and FDA approval for treatment of peripheral arterial disease, and recently received a CE mark for use in PEs.

Saturday, January 1, 2011

Best Musicians IMHO

I am a Sonographer.  I am also a musician.  I have an opinion about sound.  I love the music that makes me weep.  Music can cure many ills.  Best Musicians in my life time:  Well, heck you see the picture.  Best bassist: Geddy Lee.  Best guitarist:  Steve Howe  Best vocalist:  Jon Anderson.  Best percussionist: that bald guy from Genisus.  Best dancer?  Who cares.  Best  Musician?  Keith Emerson.  Runner up?  Tony Banks.  Happy New Year.