Ultrasound Guidance and Display

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Ultrasound is the most common medical image, recently surpassing x-rays. Point-of-care is the fastest growing sector in ultrasound, especially anesthesiology. This growth is driven by several trends in ultrasound: miniaturization, cost-reduction, and advanced digital image processing on generic hardware. A typical use-case is to target a peripheral nerve with ultrasound, then guide a needle to that target and inject anesthesia. The problems limiting further growth are that the image quality is still often inadequate, and the point-of-care operators are novices/untrained in ultrasound. Operators still struggle with the hand-eye coordination needed to guide a needle to the target in the patient based on an often-noisy image on a bedside monitor. What is needed is a significant leap in image quality and ease-of-use for specific clinical applications. Such a leap would not only benefit point-of-care applications, but in the long term could finally open the ultrasound market to primary care physicians in neighbourhood offices. Primary care physicians comprise one third of all physicians and see 51% of all office visits, but do not widely use ultrasound due to these problems. This grant will develop methods to improve image quality in both 2D and 3D, and improve ease-of-use by projecting key information directly on the patient.***Better 2D image quality will be addressed by improving the imaging speed and then capturing more information before forming a final image. Previously, increasing speed compromised spatial detail or depth penetration. We propose to leverage recent advances in telecommunications, namely digital codes, to develop new fast ultrasound imaging techniques without this compromise. As the first applications, we will aim specifically to improve the image quality of bone surfaces and nerves because they are key for many procedures in anesthesiology. ***Better 3D image quality will be addressed by using fast imaging to quickly sweep the ultrasound transducer over a region of interest to capture a 3D panorama, without blurring or encountering inadvertent patient motion.***Better ease-of-use will be addressed by improving the way the anatomical and guidance information is presented to the physician. We will develop a simple, low cost, augmented reality display directly over the region of interest on the patient, in addition to the usual monitor at the patient bedside. This will include the depictions of the target location, identified in ultrasound, and appropriate needle trajectory. ***All of these techniques can be implemented individually or together on commercial ultrasound machines starting with the Canadian-made Ultrasonix. These techniques will make several anesthesia procedures easier and more accurate than current "blind" injections, which should translate into better and greater access to anesthesia. Fewer complications from misplaced needles will also reduce hospital costs.**