There is currently a variety of existing ultrasound systems that include wired or wireless ultrasound probes connected to visual displays. These systems may be used by a clinician to hold and manipulate the ultrasound probe to place a vascular access device (VAD) such as a catheter in a patient. Ultrasound imaging is commonly used for guiding a needle to targets such as veins of the patient. The needle may be monitored in real-time prior to and after a percutaneous insertion. This way a clinician may be able to determine the distance and the orientation of the needle in relation to a target vein and ensure accurate insertion with minimal discomfort to the patient. In some instances, a target vein may be difficult to distinguish from an adjacent artery. As such, in some instances, the clinician may inadvertently puncture an adjacent artery. A puncture of an artery may cause harm and/or discomfort to the patient. The arterial puncture may also require unplanned intervention by the clinician to stop bleeding from the artery. Thus, distinguishing a vein from an artery prior to needle insertion may inhibit harm and discomfort to a patient and may be logistically advantageous for the clinician.
Accordingly, disclosed herein are ultrasound imaging systems and methods that distinguish arteries from veins based on, at least, blood vessel differentiating characteristics.
Briefly summarized, disclosed herein is an ultrasound system including, an ultrasound probe comprising a plurality of ultrasound transducers configured to acquire ultrasound images. The system further includes a processor and non-transitory computer-readable medium having stored thereon a logic module that, when executed by the processor, is configured to perform operations including, receiving real-time ultrasound imaging data, detecting one or more blood vessels within the ultrasound imaging data, 1) identifying at least one blood vessel of the one or more blood vessels as an artery or 2) identifying at least one blood vessel of the one or more blood vessels a vein, and rendering a visualization of at least a subset of the one or more blood vessels on a display of the console.
In some embodiments, the processor, the non-transitory, computer-readable medium and the display screen comprise a console. In some embodiments, the ultrasound imaging system includes an operation identifying the blood vessel as an artery.
In some embodiments, the system employs at least one differentiating characteristic among a plurality of differentiating characteristics when identifying the blood vessel. The differentiating characteristics are defined by the logic module and include a blood vessel diameter, a blood vessel wall thickness, an image pulsatility of a blood vessel, a depth of a blood vessel with respect to a skin surface of a patient, a location of a first blood vessel in relation to a location of a blood second vessel, and a cross-sectional shape of a blood vessel.
In some embodiments, the system employs at least two differentiating characteristics when identifying the blood vessel.
In some embodiments, the logic module defines one or more thresholds employed when identifying a blood vessel.
In some embodiments, the logic module includes an operation of identifying at least one differentiating characteristic of the blood vessel within the real-time imaging data.
In some embodiments, the logic module includes an operation of comparing the real-time imaging data pertaining to a differentiating characteristic with one or more thresholds defined by the logic module resulting in a confidence level for the identification of the blood vessel.
In some embodiments, the real-time imaging data includes image pulsatility data of the blood vessel, and wherein identifying the blood vessel includes comparing the image pulsatility data to one or more image pulsatility thresholds to obtain the confidence level for the identification of the blood vessel.
In some embodiments, the ultrasound probe of the ultrasound imaging system includes a pressure sensor configured to obtain pressure pulsatility data of the blood vessel and the logic module includes an operation of receiving real-time pressure pulsatility data in coordination with receiving real-time imaging data. The logic module includes a differentiating characteristic pertaining to pressure pulsatility of a blood vessel, and an operation of the logic module includes comparing the pressure pulsatility data of the blood vessel to one or more pressure pulsatility thresholds to obtain a confidence level for the identification of the blood vessel.
In some embodiments, comparing the pressure pulsatility data is performed in combination with comparing the image pulsatility data to obtain a combined confidence level for the identification of the blood vessel.
In some embodiments, the logic module includes an operation of rendering a visualization of one or more blood vessels on the display of the console and includes rendering indicia on the display to indicate to the clinician if any of the blood vessels is an artery.
In some embodiments, the logic module includes operations of tracking a position of a needle tip in relation to the one or more blood vessels, and generating an alert to a clinician if the needle tip is positioned within a perimeter threshold of an artery. The alert may further include rendering indicia on the display that includes a text notification or an arrow indicating a direction to move the needle away from the artery.
In some embodiments, the ultrasound imaging system includes an artificial intelligence module configured to define the thresholds. In some embodiments, the artificial intelligence module may define one or more of the differentiating characteristics.
Disclosed herein is a method for identifying an artery among a plurality of blood vessels, including obtaining ultrasound images via an ultrasound imaging system. The ultrasound imaging system includes an ultrasound probe having a plurality of ultrasound transducers configured to acquire ultrasound images and a console. The console includes a processor and non-transitory computer-readable medium having stored thereon a logic module configured to perform operations. The operations include receiving real-time ultrasound imaging data, detecting one or more blood vessels within the ultrasound imaging data, identifying at least one blood vessel of the one or more blood vessels as an artery or identifying at least one blood vessel of the one or more blood vessels as a vein.
In some embodiments of the method, the operations include identifying the blood vessel as an artery.
In some embodiments of the method, the logic module includes an operation of rendering a visualization of at least a subset of the one or more blood vessels on a display of the console, wherein the subset includes the blood vessel. The rendering operation may further include rendering indicia on the display indicating that the blood vessel is an artery.
In some embodiments of the method, the operations include identifying at least one differentiating characteristic of the blood vessel within the real-time imaging data, and comparing the real-time imaging data to one or more thresholds defined by the logic module to obtain a confidence level that the blood vessel is an artery.
In some embodiments of the method, identifying a blood vessel as an artery includes, receiving image pulsatility data for the blood vessel, and comparing the image pulsatility data to one or more image pulsatility thresholds to obtain the confidence level that the blood vessel is an artery.
In some embodiments of the method, the ultrasound probe further comprises a pressure sensor configured to obtain pressure pulsatility data in combination with acquiring ultrasound images, and wherein identifying a blood vessel includes, receiving pressure pulsatility data for the blood vessel, and comparing the pressure pulsatility data to one or more pressure pulsatility thresholds defined by the logic module to obtain an additional confidence level for the identification of the blood vessel.
These and other features of the concepts provided herein will become more apparent to those of skill in the art in view of the accompanying drawings and following description, which describe particular embodiments of such concepts in greater detail.
A more particular description of the present disclosure will be rendered by reference to specific embodiments thereof that are illustrated in the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope. Example embodiments of the invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:
Before some particular embodiments are disclosed in greater detail, it should be understood that the particular embodiments disclosed herein do not limit the scope of the concepts provided herein. It should also be understood that a particular embodiment disclosed herein can have features that can be readily separated from the particular embodiment and optionally combined with or substituted for features of any of a number of other embodiments disclosed herein.
Regarding terms used herein, it should also be understood the terms are for the purpose of describing some particular embodiments, and the terms do not limit the scope of the concepts provided herein. Ordinal numbers (e.g., first, second, third, etc.) are generally used to distinguish or identify different features or steps in a group of features or steps, and do not supply a serial or numerical limitation. For example, “first,” “second,” and “third” features or steps need not necessarily appear in that order, and the particular embodiments including such features or steps need not necessarily be limited to the three features or steps. Labels such as “left,” “right,” “top,” “bottom,” “front,” “back,” “upward,” “downward,” and the like are used for convenience and are not intended to imply, for example, any particular fixed location, orientation, or direction. Instead, such labels are used to reflect, for example, relative location, orientation, or directions. Singular forms of “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise. Also, the words “including,” “has,” and “having,” as used herein, including the claims, shall have the same meaning as the word “comprising.”
Lastly, in the following description, the terms “or” and “and/or” as used herein are to be interpreted as inclusive or meaning any one or any combination. As an example, “A, B or C” or “A, B and/or C” mean “any of the following: A; B; C; A and B; A and C; B and C; A, B and C.” An exception to this definition will occur only when a combination of elements, components, functions, steps or acts are in some way inherently mutually exclusive.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by those of ordinary skill in the art.
Ultrasonic transducers 130 located in a probe head 102 of the ultrasound probe 101 are configured to capture 2-D ultrasound images to be visualized on a display of the console 105 in an ultrasound image window 122. The ultrasonic transducers 130 may be arranged and/or activated in a linear array or a 2-D array. The ultrasonic transducers 130 may be implemented as piezoelectric transducers or capacitive micro-machined ultrasonic transducers (CMUTs). When the ultrasound probe 101 is configured with the 2-D array of the ultrasonic transducers 130, a subset of the ultrasonic transducers may be linearly activated as a linear array as may be beneficial for ultrasound imaging based on ultrasound-imaging data being captured. The ultrasound transducers 130 may be configured to maintain the target, such as the vein 110, in an image plane parallel to a medical-device plane or switch to a different image plane perpendicular to the medical-device plane. In some embodiments, the ultrasound probe 101 may be configured with the moveable linear array of the ultrasonic transducers 130 that may be activated for ultrasound imaging.
In use, the probe head 102 may be placed against the skin 104 of a patient proximate to a needle-insertion site so the activated ultrasonic transducers 130 in the probe head 102 may generate and emit the ultrasound signals into the patient as a sequence of pulses. Transmitters within the probe head 102 (not shown) may receive reflected ultrasound signals (i.e., reflections of the generated ultrasonic pulses from the patient's body). The reflected ultrasound signals may be converted into corresponding electrical signals for processing into ultrasound images by a console of the ultrasound imaging system 100. Thus, a clinician may employ the ultrasound imaging system 100 to determine a suitable insertion site and establish vascular access to the target vein 110 with the needle 112 or another medical device.
As discussed above, the exemplary ultrasound imaging system 100 may be capable of detecting and identifying a vein 110 and an artery 120 and providing a visualization of veins 110 and arteries 120 in the ultrasound window 122. While a single vein 110 and a single artery 120 are shown in
Additionally, as will be discussed below, the ultrasound imaging system 100 may include one or more logic modules that, upon processing by a processor, are capable of processing the obtained ultrasound images, identifying one or more blood vessels (e.g., the artery 120 and the vein 110) and distinguishing the artery 120 from the vein 110. For example, the logic modules(s) of the ultrasound imaging system 100 may identify an artery 120 and distinguish the artery 120 from the vein 110 according to a plurality of differentiating characteristics. As one illustrative embodiment, the artery 120 may have a smaller diameter and a thicker wall than the vein 110, which may be detected and identified by the logic modules. As another illustrative embodiment, the artery 120 may have a higher internal pressure than the vein 110 and may have detectable variations of its diameter due to pressure pulses within the artery 120, whereas the vein 110 may have small or non-detectable pressure pulses. The ultrasound imaging system 100 may provide real-time imaging information of a blood vessel, e.g., size, cross-sectional shape, wall thickness, and movement the blood vessel or portions thereof. The ultrasound imaging system 100, via processing of the ultrasound images by the one or more logic modules, may provide detection and identification of the vein 110 and/or the artery 120 for general monitoring, diagnostics, or assessment prior to and/or post an intervention. In some embodiment, the one or more logic modules may identify fluid or body cavities (e.g., pleural space); therefore, the discussion provided herein pertaining to detection and identification of blood vessels may also apply to pleural space. It will be understood by those having skill in that art that certain embodiments described herein may only be applicable to blood vessels (e.g., distinguishing an artery from a vein).
In some embodiments, the ultrasound imaging system 100 may be configured to detect and track a position of the needle 112. In one embodiment, the ultrasound imaging system 100 may include positional tracking of the needle 112 with respect to a target, e.g., the vein 110. The clinician may adjust the position of the needle 112 for correct placement of the needle 112 in relation to the vein 110 in response to ultrasound imaging displayed in the ultrasound window 122. In some embodiments, the needle tracking can be implemented using the teachings of one or more of the following: U.S. Pat. Nos. 9,456,766, 9,492,097, 9,521,961, 9,554,716, U.S. Ser. No. 10/524,691, U.S. Ser. No. 10/449,330, and US 2018/0116551, each of which is incorporated by reference in its entirety into this application.
As described above, in some embodiments, the probe head 102 of the ultrasound probe 101 may include the pressure sensor 240 capable of and configured to detect pressure pulses 340 emanating from the artery 120.
In some embodiments, the logic modules of the ultrasound imaging system 100 may be configured to determine a pressure within the vein 110 and/or the artery 120 based on the pressure pulses 340 (and optionally, the ultrasound signals 330). In one instance, the compressive pressure 340 may be sufficient to cause the artery 120 to totally collapse only in the absence of a pressure pulse. In such an instance, the compressive pressure 340 as measured by the pressure sensor 240 may be indicative of a diastolic blood pressure within the artery 120. In a corresponding instance, the compressive pressure 340 may be sufficient to cause the artery 120 to totally collapse and remained collapsed throughout the pressure pulse. In this corresponding instance, the compressive pressure 340 as measured by the pressure sensor 240 may be indicative of a systolic blood pressure within the artery 120.
Referring to
A digital controller/analog interface 422 may be included with the console 105 and be in communication with both the processor 416 and other system components to govern interfacing between the ultrasound probe 101 and other system components set forth herein. The ultrasound imaging system 100 further includes ports 424 for connection with additional components such as optional components 426 including a printer, storage media, keyboard, etc. The ports 424 may be implemented as universal serial bus (USB) ports, though other types of ports can be used for this connection or any other connections shown or described herein. A power connection 428 is included with the console 105 to enable operable connection to an external power supply 430. An internal power supply 432 (e.g., a battery) may also be employed either with or exclusive of the external power supply 430. Power management circuitry 434 is included with the digital controller/analog interface 422 of the console 105 to regulate power use and distribution. Optionally, a stand-alone optical interrogator 454 may be communicatively coupled to the console 105 by way of one of the ports 424. Alternatively, the console 105 may include an optical interrogator integrated into the console 105. Such an optical interrogator may be configured to emit input optical signals into a companion optical-fiber stylet 456 for shape sensing with the ultrasound imaging system 100. The optical-fiber stylet 456, in turn, may be configured to be inserted into a lumen of a medical device such as the needle 112 (
The optical interrogator 454 may be configured to convert the reflected optical signals into corresponding electrical signals for processing by the console 105 into distance and orientation information with respect to the target and for dynamically adjusting a distance of the activated ultrasonic transducers 130, an orientation of the activated ultrasonic transducers 130, or both the distance and the orientation of the activated ultrasonic transducers 130 with respect to the target (e.g., the target vein 110, depicted in
The display 404 may be integrated into (or connected to) the console 105 to provide a graphical user interface (GUI) and display information for a clinician in a form of ultrasound images acquired by the ultrasound probe 101. In addition, the ultrasound imaging system 100 may enable the distance and orientation of a magnetized medical device such as the needle 112 to be superimposed in real-time atop an ultrasound image, thus enabling the clinician to accurately guide the magnetized medical device toward an intended target (e.g., the vein 110) and/or away from an artery 120 (
The ultrasound probe 101 may be employed in connection with ultrasound-based visualization of a target such as the vein 110 (
As stated above, the ultrasound probe 101 includes ultrasonic transducers 130 (see
The ultrasound imaging system 100 includes at least one logic module 420 configured to perform various operations when executed by the processor 416. The logic module 420 may, when executed by the processor 416, perform operations including receiving ultrasound imaging data, detecting one or more blood vessels within the ultrasound imaging data, identifying a blood vessel as an artery, and generating a visualization from the ultrasound image that renders the blood vessel as an artery. The operation may further include generating an alert indicating to a clinician that a procedure may need to be halted or adjusted, such as a needle insertion procedure, to prevent puncturing an artery, for example.
Identifying of a blood vessel as an artery may include comparing imaging data for the blood vessel with thresholds stored in the memory 418 pertaining to arteries and/or veins. The logic module 420 may further define a result of the comparison that the blood vessel is an artery or a vein according to a level of confidence. In some embodiments, indicia rendered on the display may include the level of confidence, such as 90% confidence, for example.
In one embodiment, a logic module 420 may be configured to detect a blood vessel size such as a cross-sectional diameter of the blood vessel. The logic module 420 may further compare the size of the vessel to one or more thresholds pertaining to the blood vessel diameter of arteries and/or veins. The logic module 420 may further define a result of the comparison that the blood vessel is an artery or a vein according to a level of confidence.
In one embodiment, a logic module 420 may be configured to detect a vessel wall thickness. The logic module 420 may further compare the vessel wall thickness to one or more thresholds pertaining to the blood vessel wall thicknesses of arteries and/or veins. The logic module 420 may further define a result of the comparison that the blood vessel is an artery or a vein according to a level of confidence.
In one embodiment, a logic module 420 may be configured to detect image pulsatility of a vessel, i.e., the changing of the vessel diameter due to pressure pulsing within the blood vessel. The logic module 420 may further compare the image pulsatility to one or more thresholds pertaining to the image pulsatility of arteries and/or veins. The logic module 420 may further define a result of the comparison that the blood vessel is an artery or a vein according to a level of confidence.
In one embodiment, a logic module 420 may be configured to detect a depth of the blood vessel with respect to the skin surface of the patient. The logic module 420 may further compare the depth to one or more thresholds pertaining to the depth of arteries and/or veins. The logic module 420 may further define a result of the comparison that the blood vessel is an artery or a vein according to a level of confidence.
In one embodiment, a logic module 420 may be configured to detect a difference in depth between a first blood vessel and a second blood vessel. The logic module 420 may further compare the depth difference to one or more thresholds pertaining to the depth of arteries with respect to the depth of veins. The logic module 420 may further define a result of the comparison that the blood vessel is an artery or a vein according to a level of confidence.
In one embodiment, a logic module 420 may be configured to detect a cross-sectional shape of a blood vessel. In some instances, a cross-sectional shape of a vein may be non-round, i.e., oval or flattened, due to the lower pressure within veins, contact with bones or other structure within the body, etc. By way of contrast, the pressure within an artery may generally cause the cross-sectional shape of an artery to be substantially round. The logic module 420 may further compare the cross-sectional shape to one or more thresholds pertaining to the cross-sectional shapes of veins and/or arteries. The logic module 420 may further define a result of the comparison that the blood vessel is an artery or a vein according to a level of confidence.
In some embodiments, a logic module 420 may be configured to identify a blood vessel as an artery or as a vein based on one or more differentiating characteristics of the blood vessel within an anatomical frame of reference, wherein the anatomical frame of reference may include an ultrasound image that renders visualization of the blood vessel in relation to other anatomical characteristics such as bones, tendons, ligaments, organs, a shape of an extremity, a skin surface, and/or other blood vessels, for example. In some embodiments, a logic module 420 may be configured to further identify the blood vessel as an artery or as a vein and/or obtain a greater level of confidence by changing the anatomic frame of reference. Changing the anatomic frame of reference may include altering the visualization to include more or fewer other anatomical characteristics and/or generating the ultrasound image at a different angle relative to the blood vessel or fluid or body cavities (e.g., pleural space).
In one embodiment, a logic module 420 may be configured receive pressure pulsatility data detected by the pressure sensor 240 at the skin surface, and thereby, detect a pressure pulsatility of a blood vessel. The logic module 420 may further compare the pressure pulsatility to one or more thresholds pertaining the pressure pulsatility of arteries and/or veins. The logic module 420 may further define a result of the comparison that the blood vessel is an artery or a vein according to a level of confidence.
In one embodiment, a logic module 420 may be configured receive contact pressure data detected by the pressure sensor 240 at the skin surface, the contact pressure data reflecting a compressive pressure of the probe head 102 (see
In one embodiment, a logic module 420 may be configured to receive needle-tracking imaging data in combination with identifying a blood vessel. In some embodiments, the logic module 420 may utilize needle tracking to facilitate selection of a blood vessel as a target, such as a target vein. In some embodiments, the clinical may select the target blood vessel by positioning the needle 112 in close proximity to the target blood vessel, i.e., within a predetermined threshold distance from the target blood vessel. Once selected, the logic module 420 may provide feedback to the clinician that the target blood vessel is selected, which feedback may include rendering visualization indicia indicating that the target blood vessel is selected.
In some embodiments, the logic module 420 may detect a position of a tip of the needle 112 (see
The logic module 420 may combine individual confidence levels (i.e., confidence levels associated with individual differentiating characteristics) to produce a combined confidence level that is greater than any of the individual confidence levels.
The ultrasound imaging system 100 may include an artificial intelligence (AI) module 405 (which may be a sub-module of the logic module 420) that may be employed for identifying a blood vessel as an artery or a vein or otherwise distinguishing an artery from a vein. The AI module 405 may be integrated into the console 105, coupled to the console 105, or accessed remotely on a separate server. The AI module 405 may be configured to receive and process training data sets that include data pertaining to differentiating characteristics which may comprise size or diameter of the blood vessel, position of the blood vessel relative to a skin surface or other body structure, relative position between adjacent blood vessels, motion or changing diameter of blood vessel in response pressure pulsing within the blood vessel, cross-section shape of the blood vessel, cross-section shape of the blood vessel in response to applied pressure, and wall thickness of the blood vessel.
In one example, processing of the AI module 405 may include generation of a machine-learning (ML) model and training of the ML model using received one or more training data sets. The ML model may then be deployed to score ultrasound signals and/or pressure pulse data to detect and/or identify particular targets, such as blood vessels and more specifically, veins or arteries. In some embodiments, the trained ML model may be stored in the memory 418.
The AI module 405 may apply algorithms or other logic operations to define a set of thresholds for any or all of the differentiating characteristics. The AI module 405 may define an initial default set of thresholds via an initial training set of AI data. The logic module 420 may apply default thresholds defined by the AI module 405 in identifying a blood vessel as an artery or a vein or otherwise distinguishing an artery from a vein. In some instances, the AI module 405 may incorporate additional AI data to add precision to the set of thresholds or otherwise redefine a set of thresholds. In some instance, the AI module may define additional differentiating characteristics together with associated thresholds.
In some embodiments, the logic module 420 may store, monitor, and/or analyze data pertaining to confidence levels generated during comparison of real-time data with a set of thresholds. The logic module 420 may then instigate a process of incorporating additional imaging data into the AI process and generate a new and improved set of thresholds.
Embodiments of the invention may be embodied in other specific forms without departing from the spirit of the present disclosure. The described embodiments are to be considered in all respects only as illustrative, not restrictive. The scope of the embodiments is, therefore, indicated by the appended claims rather than by the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.
This application claims the benefit of priority to U.S. Provisional Application No. 63/120,053, filed Dec. 1, 2020, which is incorporated by reference in its entirety into this application.
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