WO2005074809A1 - Dispositif pour mesurer le fonctionnement d'un poumon - Google Patents

Dispositif pour mesurer le fonctionnement d'un poumon Download PDF

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Publication number
WO2005074809A1
WO2005074809A1 PCT/EP2005/001145 EP2005001145W WO2005074809A1 WO 2005074809 A1 WO2005074809 A1 WO 2005074809A1 EP 2005001145 W EP2005001145 W EP 2005001145W WO 2005074809 A1 WO2005074809 A1 WO 2005074809A1
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WO
WIPO (PCT)
Prior art keywords
ultrasound
receiver
ultrasonic
lung
signal
Prior art date
Application number
PCT/EP2005/001145
Other languages
German (de)
English (en)
Inventor
Dirk Rüter
Original Assignee
Rueter Dirk
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from DE200420001776 external-priority patent/DE202004001776U1/de
Priority claimed from DE202004002930U external-priority patent/DE202004002930U1/de
Priority claimed from DE200420006536 external-priority patent/DE202004006536U1/de
Application filed by Rueter Dirk filed Critical Rueter Dirk
Priority to DE112005000234T priority Critical patent/DE112005000234A5/de
Publication of WO2005074809A1 publication Critical patent/WO2005074809A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B7/00—Instruments for auscultation
    • A61B7/003—Detecting lung or respiration noise
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/0816—Measuring devices for examining respiratory frequency
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/13—Tomography
    • A61B8/15—Transmission-tomography

Definitions

  • the invention relates to a device according to the preamble of claim 1.
  • atelectasis This is a section of the lung that is not filled with air, usually caused by a local collapse of the lungs.
  • the alveoli here have collapsed or are filled with fluid.
  • the affected area of the lungs no longer participates in gas exchange in the lungs, respiration.
  • pneumonia pneumonia
  • Pneumonia is a significant life threatening for a weakened patient.
  • correct and individual adaptation of the ventilation parameters such as pressure, volume, etc. is important to avoid such less ventilated lung areas.
  • Fig. La frontal X-rays of an intact lung (Fig. La) and a lung with an atelectasis in the lower right lung (Fig. Lb) are compared. Most of the time, postoperative respiratory patients are unilaterally affected by a lower section of the lung (somewhat less often a middle section).
  • impedance tomography is known.
  • this technique which is described, for example, in Hahn G, Sipinkova I, Baisch F, et al. "Changes in thoracic impedance distribution under different ventilatory conditions.”, Physiol. Meas. 1995, 16, A161-A173, several electrodes are applied to the patient's body. A sequence of current patterns is fed in via these electrodes. For example, a current is fed into the body via one electrode and out of the body via another electrode. All other electrodes are used as measuring electrodes and the voltage applied to them is measured.
  • the positive thing about impedance tomography is that the currents used are largely harmless for the patient.
  • the measurement method can be carried out over a longer period of time and allows a spatial resolution. Cross-sectional images of the lungs can be generated almost continuously. Disadvantages of this method, however, are the low stability against disturbances and the great computational effort to infer physiological parameters from the measurement results, for example the lung density.
  • the currents flow undirected in the body.
  • the low dynamics of the useful signal ie the low signal contrast, for example, between the inspiratory and the expiratory state of the lungs.
  • Another reason is the difficulty in adequately describing the running processes mathematically. The mathematical evaluation is not very stable and only leads to a result if certain previous expectations are included.
  • impedance tomography has a considerable blurring in the direction of the longitudinal axis of the body.
  • the reconstruction of lung properties in the direction of the longitudinal axis of the body is only possible with considerable additional effort.
  • impedance tomography which measures the specific electrical resistance, only an indirect conclusion is drawn about the air content of the tissue, and from here again only an indirect conclusion about the alveolar ventilation.
  • the attachment of many high-quality electrical contacts around the chest of an intensive care patient involves considerable effort in terms of electrical safety and quality of the measurement technology. So far, impedance tomography has been a relatively prone to failure and very process that is to be carried out is not yet practical, especially not in the fast and time-critical environment of an intensive care unit.
  • the lungs are checked with manual percussion.
  • the procedure is based on a thorax tapping by a doctor.
  • the lung condition is then deduced from the knocking noises (frequencies below 1 kHz) that are more or less "dull” or "damped".
  • This method is very dependent on the experience of the performing doctor. Percussion is therefore a subjective manual method, not exactly reproducible and in particular not suitable as a continuous, spatially resolving continuous monitoring.
  • a generic device for measuring lung function is known from Technischen Messen 69 (2002) 4, page 194 ff "Acoustic Diagnostics of the Lung”.
  • the procedure represents an objective-technical implementation of the manual Percussion.
  • Acoustic audible sound in the frequency range from below 100 Hz to 1 kHz is radiated into the body via a sound transmitter attached to the chest.
  • the sound signal is then picked up by a sound receiver arranged on the opposite side of the body.
  • the method is technically simple and basically suitable for a regular or permanent functional test of the lungs. Due to the technical design - as with percussion - the sound in this process spreads at a low speed of 30 - 300 m / s in the lung tissue.
  • the method is designed in such a way that sound transmission in the lungs is preferably carried out through the air-filled lung areas (bronchioles, bronchi, ). In particular, the closing of such a tubular sound channel results in a high signal change.
  • the method reacts to a change in the general air content of the lungs, but is not specific or selective with regard to alveolar ventilation or the filling and emptying of the alveoli. Due to the measurement methodology, the local resolution is very limited because only relatively low frequencies are used. In fact, practically only frequencies below about 1 kHz can be used. Above about 1 kHz, this method results in such strong sound attenuation in the lung tissue that meaningful signal evaluation is no longer possible. There are also considerable problems with sound coupling.
  • the transmitters and receivers using this method are designed for low frequencies (typically a few hundred Hz) and are correspondingly voluminous and bulky in design.
  • care must be taken to ensure that the sound is introduced or removed between the ribs, because the ribs represent mechanical stiffening and thus an obstacle to sound.
  • US Pat. No. 6,443,907 discloses a diagnostic method of a non-generic type in which sound audible via the airway is radiated into the lungs. Also
  • the sound propagates at low speed (typically less than 300 m / s) in the lung tissue and preferably in the trachea.
  • a sound receiver arranged on the chest records a transmitted sound signal. It works with sound with frequencies up to a maximum of 2 kHz. Likewise, only the lower frequency range around a few hundred Hz is preferred and practically usable according to this method. Again, attenuations in the lung tissue are so strong for frequencies from approximately 1 kHz that useful signal evaluation is no longer possible.
  • a sound supply line must be routed to the patient via the respiratory tract, which is a disturbing burden. This device also lacks selectivity with regard to alveolar ventilation.
  • the lung tissue shows a strong reflectivity or scattering power
  • the attenuation of the lung tissue is almost independent of ventilation with this methodology is only a very local and superficial part visible in the lungs, and only with careful positioning and alignment of the transducer between the highly absorbent ribs.
  • US 5,485,841 a non-imaging diagnostic method is known, which also works at frequencies above 1 MHz.
  • the strongly scattering or backscattering property of the lung tissue is also exploited here.
  • the ultrasound signal also has a limited depth of penetration into the lungs. Spectral changes in the backscatter signal or reflection signal of 1-10 MHz are measured, which result depending on whether the patient has inhaled more or less. The spectral changes are not very strong, however, they depend very much on the positioning and orientation of the transmitter, which must be arranged in the spaces between the ribs.
  • the lung tissue behaves at low acoustic frequencies, e.g. B. at 1 kHz, very resistive (highly absorbent, non-scattering or reflective) with a low overall sound speed of only 30 - 300 m / s.
  • the device should preferably also allow the measurement of the alveolar ventilation.
  • the device according to the invention works with ultrasonic sound signals in the low-frequency ultrasonic range between 5 and 1000 kHz, in particular with frequencies between 10 and 1000 kHz.
  • an ultrasound transmitter which emits ultrasound into the body
  • An ultrasound receiver which is also on the body, e.g. arranged on the chest, receives the ultrasound signal after passing through the body and through an area of the lungs.
  • the received signal contains the desired information about the lungs, since the ultrasound interacts with the lungs on its way through the body, e.g. by being dampened, reflected, slowed down, accelerated or absorbed in the lung tissue.
  • the device also includes an evaluation and control device which receives an electrical signal from the ultrasound receiver. It evaluates e.g. the signal intensities, transit times, phase shifts or the like.
  • the desired information can e.g. are extracted from the absolute signal intensities or the spectral curve, as well as their relative shift in the rhythm of breathing.
  • measurements should be taken over several breathing cycles. Continuous monitoring is possible, but the measurement can also be carried out at suitable time intervals, e.g. hourly, e.g. each for a period of a few breathing cycles.
  • the pulmonary alveoli are organized in grapes about 1 mm in size, which can be understood as acoustically uniform air bubbles in an aqueous tissue.
  • air bubbles in water have specific resonance frequencies at which the cross-section of interaction with sound increases very strongly (very strong absorption or scattering).
  • the calculated maximum frequency of absorption or scattering is about 3.5 kHz.
  • the very high dispersion of the lung tissue between 1 and 10 kHz can therefore be understood as a specific effect of the numerous pulmonary alveoli.
  • the working frequency selected in accordance with the invention and capable of spreading in the lungs in the low ultrasound range from typically 5-10 kHz is just above the strong dispersion and is therefore very effective.
  • the resistive part of the scatter is still present, i.e. the sound absorption variable with ventilation, and not just the strong reactive component known at MHz frequencies. Therefore, with the device according to the invention, ventilation-dependent attenuations (sound absorption) in the lung tissue can also be measured very well and very dynamically, and not only the known ultrasound effects of reflection and scattering.
  • the device is relatively insensitive to the ribs.
  • the received signal of the receiver - unlike in the prior art - is not significantly impeded or disturbed by ribs.
  • Smaller transmitters and receivers can also be used. This enables compact, soft and flat transmitter reception systems that can be used particularly well in intensive care settings.
  • the use of ultrasound gel can be dispensed with at the low ultrasound frequencies.
  • the ultrasound according to the invention differs fundamentally in its physical properties - for example high speed of sound - and in its specific interaction with the lungs from the acoustic sound phenomena at even lower frequencies - here, for example, significantly lower speed of sound - according to the prior art discussed above.
  • a single ultrasound transducer can also be used simultaneously as an ultrasound transmitter and receiver, e.g. intermittently.
  • the device according to claim 3 can also operate in a frequency range from 10 to 200 kHz or a sub-range thereof, advantageously according to claim 4 in a frequency range from 10 to 50 kHz or a sub-range thereof, and according to claim 5 in a frequency range from 10 - 30 kHz.
  • the strong resistive effects can be favorably reduced.
  • the damping of the lung tissue varies greatly with the local ventilation or the alveolar ventilation.
  • the transit time and the speed of sound can be measured here.
  • the runtime effects speed of sound
  • the runtime effects can be measured more sharply and more reactive effects have the upper hand (reflectivity, echo signal for depth profiles, scattering of the lung tissue). Because of the shorter wavelengths, higher-resolution tomography is possible here.
  • the device can measure, for example, in the transmission position. It can also measure in reflection.
  • Bent transmission is understood to mean that the signal travels from the transmitter through the body to a receiver on a curved path.
  • the ultrasonic signal changes its direction by almost 180 °.
  • the features of claim 7 are advantageously provided.
  • the transmitter and receiver must be arranged so that the ultrasound can penetrate the lung to be examined. It is therefore preferred to mount both the transmitter and the receiver on the patient's upper body in the immediate vicinity of the lungs. It has proven to be advantageous to utilize the property of the heart as a good conductor for ultrasound of the abovementioned frequencies in that the transmitter or receiver is arranged on the body near the heart. In this way, a simple, radial and location-specific transmission of the respective lung section can be achieved. Even when arranged on the spine, there is good access to the heart.
  • the heart can act as a radially radiating ultrasound center and a measurement can be carried out particularly well in a transmission arrangement in which the transmitter and receiver are arranged on different, in particular opposite sides of the body. However, it could also be radiated in through the abdominal cavity as a sound conductor.
  • the device can also work with only one ultrasonic transducer. It can also work with an ultrasound transmitter and an ultrasound receiver.
  • the features of claim 8 are advantageously provided. With a suitable distribution of the receivers, there is an improved spatial resolution because each receiver receives an ultrasound signal that has passed through different lung areas. In this way, it can be localized more precisely, for example, at which point, for example, an atelectasis is present.
  • the ultrasound signal could, for example, be a sine, sweep, or a noise signal, it could be narrow-band, for example.
  • the features of claim 9 are advantageously provided. A noise signal in the weakly audible foothills, for example, is perceived by the patient as less acoustically disturbing than, for example, a sweep signal.
  • pulse signals are advantageous in the evaluation, for example, according to transit times, in particular if sequential switching is carried out between several transmitters or receivers.
  • Broadband radiation is preferable to narrowband signals, since there is a risk of narrowband radiation that there is no or only a slight difference between intact and damaged lungs at this frequency. It can only be roughly predicted at which frequency differences can advantageously be identified, because this is patient-specific. It can be seen that optimal frequencies can vary, for example in adults and children, in men and women, in the trained and untrained.
  • broadband noise or broadband pulses it is reliably ensured that a suitable frequency range is recorded for the evaluation for each patient.
  • the transmitters and receivers can e.g. individually attached to the patient's body.
  • the features of claim 10 are advantageous for faster attachment. Only one or a few carriers then have to be attached instead of the multiple receivers. When arranged on a carrier, the receivers are also constantly positioned relative to one another, while a location assignment with individual fastening is more difficult to achieve and prone to errors.
  • the wiring can also be simplified.
  • the carrier can be fastened, for example, by gluing or another method known in the prior art.
  • the features of claim 1 1 are advantageously realized.
  • a belt can be put on the patient quickly and can be worn comfortably for a long time. After the belt is put on, the receivers distributed on the belt are distributed around the body in the intended and defined manner, for example around the thorax.
  • the belt can be elastic, for example.
  • a suitable material according to claim 13 is e.g. a polymer foam.
  • the belt Since the belt is used in the medical and clinical fields, the merl ⁇ nale of claim 14 are advantageously provided. As an alternative to this, the belt could also be manufactured as a disposable item or covered with an exchangeable sterile film.
  • the carrier and the transmitter and / or receiver arranged thereon can e.g. be firmly connected.
  • the ultrasonic transducers e.g. can be attached to different belts, e.g. selected according to patient size.
  • individual converters can be replaced in the event of malfunction or damage.
  • the belt and receiver can also be disinfected or sterilized separately.
  • the belt could also be designed as a disposable item.
  • the features of claim 16 can advantageously be provided. Such an arrangement enables a particularly good spatial limitation of possible lung damage and can be used for a visual representation of the measurement results, for example by suitable temporal and spatial control of the transmitter and receiver.
  • the features of claim 17 are advantageously provided. As a result, the receivers fit better against the body and with higher contact pressure.
  • the evaluation and control device can operate according to the features of claim 18. It then receives information on different lung areas in quick succession, and can e.g. calculate an overall lung image and show it on a display provided for this purpose.
  • sectional views of the lungs can advantageously be generated.
  • the section level in the views corresponds to the level of the recipient.
  • the spatial resolution can thereby advantageously be increased.
  • the function of the transmitter and receiver can also be interchanged. If, therefore, a particular arrangement of the receivers and a single transmitter was previously discussed, a plurality of transmitters can also be used instead, e.g. in the same arrangement as described above for the receiver, and a single receiver.
  • the merl ⁇ nale of claim 20 are provided, the plurality of ultrasound transmitters transmitting simultaneously and acting like a transmitter.
  • the advantage is that possible contact or attenuation problems at the ultrasound coupling point are reduced if, for example, three ultrasound transmitters operated in parallel are used simultaneously in close proximity to one another. This promotes large-scale, safe and reproducible sound coupling.
  • receivers operated in parallel and spatially densely arranged can also be combined to form a reception channel in order, for. B. interference occurring at higher frequencies due to ribs in any system position.
  • the multiple transmitters are preferred designed as a structural unit and arranged in the immediate vicinity of the heart or on the spine.
  • the electronic or physical coupling or phase-adapted parallel connection of several transmitters and receivers can be used via diffraction effects for directional control or depth resolution of the sound field.
  • a so-called Ultrasc all tomography can be implemented with the aid of numerical and phase-accurate calculation of several transmitter or receiver signals.
  • the Merl ⁇ nale are provided according to claim 21, in order to ensure good ultrasound introduction into the body. Because an air gap e.g. between the ultrasound transmitter and the body represents an impedance boundary layer with an impedance jump, which leads to loss of intensity due to reflection, x
  • the coupling of the ultrasound into the body can be further improved with the features of claim 22, because the acoustic transition from a hard transducer into the thorax is significantly influenced by the contact pressure and the moisture of the interface.
  • Corresponding effects are known from ultrasound imaging technology.
  • Ultrasound gel is used there as standard to ensure reproducible and low-reflection sound transmission.
  • the use of ultrasound gel would be very cumbersome, in particular with several transducers.
  • the gel dries out, making it difficult for long-term use.
  • the proposed coupling layer for example in the form of a soft-elastic coating, causes a certain signal damping of the ultrasound, it very much reduces the influence of contact pressure and moisture on the transfer function of the interface.
  • the layer can only be applied to the transducers or also to the entire contact surface of the belt. It could also use transmitters or receivers a hard surface profile, in which the protruding structures as sound bridges have the necessary contact pressure on the body for good sound-conducting contact, because the local contact pressure near the protruding structures is often greater than with a smooth and flat support. Therefore, there is less dependence on contact pressure and moisture for sound transmission. In the long run, however, the patient could experience these structures as uncomfortable or even painful.
  • the device Since the device is to be used in the medical, and in some cases even in the intensive medical field, it must also meet sterility requirements.
  • the parts of the device that come into contact with the body could therefore e.g. be trained as a disposable item, which is disadvantageous for cost reasons.
  • Features of claim 24 are therefore advantageously provided.
  • the Merl ⁇ nale of claim 25 represent an alternative.
  • any of the types of ultrasonic transducers known in the prior art can be used.
  • the merl ⁇ nale of claim 26 are advantageously provided.
  • the device advantageously has the features of claim 27 in order to be able to save results of the measurements, for example after evaluation and conversion into an intuitively interpretable representation.
  • temporal developments in the lungs can be tracked and archived.
  • the storage can be permanent, for example, in order to be able to edit, view or use the stored data later for comparison purposes.
  • the features of claim 31 are preferably also provided.
  • the saved For example, data can also be transferred to memory outside the device, for example a hospital memory, in order to be stored in the patient file.
  • the memory used can be, for example, a removable memory or a computer memory which is connected to the device by means of a data cable.
  • the device advantageously has the merits of claim 28, ixm when a defined situation is determined, e.g. a dangerous situation to attract the attention of medical personnel or the user of the device in general. Then e.g. further examinations can be arranged or a doctor called. However, the alarm signal can e.g. a malfunction, a power supply that is only secured for a short time, or the like are also displayed.
  • a defined situation e.g. a dangerous situation to attract the attention of medical personnel or the user of the device in general. Then e.g. further examinations can be arranged or a doctor called.
  • the alarm signal can e.g. a malfunction, a power supply that is only secured for a short time, or the like are also displayed.
  • the device can be easily transported, e.g. carried by patients or by emergency physicians.
  • the device can then e.g. are carried by the patient during ongoing measurements, in particular with the advantageous features of claim 30, with which independence from power grids is achieved.
  • the power supply can take place via any current storage or generator known in the art, e.g. Batteries, accumulators, solar cells, fuel cells etc.
  • Fig. La, lb X-rays of an intact lung (la) and a lung with partial atelectasis
  • the receivers and transmitters are preferably attached in the side and back area
  • Fig. 3 a second embodiment of a device according to the invention, here too the receivers and transmitters are preferably mounted in the side and back area
  • FIG. 1b A ventral x-ray image of an intact lung 1, 2 of an adult person is shown in FIG. 1b shows a damaged lung 3, 4 in a similar ventral image.
  • an atelectasis 5 is shown as a light spot, because this lung area is another, namely has a denser tissue structure than the intact areas of the lungs, which appear as dark shadows from the surrounding tissue and skeleton.
  • Figure 2 shows a first embodiment of a device for measuring the lung function.
  • Four ultrasound transducers 21 are arranged above the lower area of the left lung 1 and two above the lower area of the right lung 2 of a patient 22 shown on the chest 23, e.g. glued.
  • the electro-acoustic transmitters and receivers 21 (only collectively referred to as transducers), which are only a few cm in size, are designed on the outside to be similar to common EKG electrodes, that is to say they are of flat design and lie well on the body 22.
  • the transducers 21 are connected to a control and evaluation unit 25, which can control each of the transducers 21 and receives an electrical signal from the transducers 21 that corresponds to an ultrasound signal picked up by the transducer 21.
  • a control and evaluation unit 25 can control each of the transducers 21 and receives an electrical signal from the transducers 21 that corresponds to an ultrasound signal picked up by the transducer 21.
  • the transducers 21 are controlled to send an ultrasound signal.
  • the signal penetrates through the skin into the body 22 and into the lungs 1, 2, and is partially reflected on its way through the body 22 by the various tissue structures.
  • the reflected signal is picked up again by the same transducers 21 that have emitted the ultrasound signal, and an electrical signal is transmitted to the control and evaluation device 25.
  • the evaluation device 25 calculates from the electrical signals obtained whether and which of the lung areas 1, 2 below one of the transducers 21 shows an abnormal interaction with the irradiated ultrasound signal, for example by an unusually high proportion of ultrasound of a certain frequency or within a certain frequency window has been transmitted or reflected. If no abnormality is found, the examined lungs 1, 2 can be considered intact. Becomes If an abnormality is found, it can be assigned to one of the transducers 21 and the location of the lung anomaly can thus be narrowed further. This measurement can be continued for many hours, for example. However, the control and evaluation device 25 can also carry out a measurement automatically or triggered by an operator at defined time intervals, which, for example, extends over several breathing cycles.
  • FIG. 3 of a further device for measuring the lung function differs from the previous example in that two transducers are arranged on a common carrier 31 and form a compact and flat functional group.
  • the transducers are arranged on the side of the carrier facing the patient's body 22; they can otherwise correspond identically to those shown in FIG. 2.
  • the carrier 31 is wired to the control and evaluation device 25 via lines 24 which run further inside the carrier 31 to the converters (not shown). Compared to the measuring process explained in connection with FIG. 2, there are no differences in this second measuring device.
  • the carrier 31 which also rests on the thorax 23 between the transducers and has sound-insulating properties in the spectral range emitted by the transducers, has the effect that adjacent transducers interfere less less, that is to say, for example, neighboring transducers do not also each measure the ultrasound signal emitted by the neighbor, which is reflected on the body surface, for example, without penetrating deeper into the body 22.
  • the transducers can be based on piezo technology, for example, and can operate in a frequency range of 10-50 kHz. For example, you can emit a broadband signal. Structure-borne noise frequencies above 10 kHz are generally not perceivable by humans, so that the patient and also the medical staff are not disturbed by the measurement signal. In FIG.
  • the device for measuring the lung function has a belt 41, on the side facing the body of which, in an array arrangement, a plurality of ultrasound receivers 21 are arranged in three rows around the body 22 and in several columns. These receivers 21 are predominantly located on the back and the lateral thoracic area of the patient 22 and are indicated by white circular areas.
  • a central ultrasound transmitter 42 is located in the immediate vicinity of the heart 43. It emits an ultrasound signal in the direction of the heart 43. From the heart 43, the ultrasound signal penetrates the two lungs 1, 2 and finally reaches the receivers 21, at which the incoming signal is measured, converted into electrical signals and passed on to the evaluation and control device 25 via a control and data line 24. The signals are processed there and displayed if necessary.
  • the central transmitter 42 is accommodated in the belt 41 in this exemplary embodiment. However, it can also be arranged separately, for example on its own carrier. This can be advantageous, for example, for the separate positioning of the transmitter 42 and the receiver 41, the transmitter also being able to be designed as a transmitter unit with a plurality of individual transmitters which, together or independently, generate an ultrasonic signal and radiate it into the body.
  • FIG. 5 shows a horizontal section through a device according to FIG. 4, the section running through the lower of the rows of receivers 21 in FIG. 4.
  • the belt 41 carries ultrasound receivers 21 on its inside, which can be detachably attached, for example, and which rest on the patient's body 22 in good sound-conducting contact.
  • the central ultrasound transmitter 42 is also attached to the inside of the belt. All transducers 21, 42 lie flat or somewhat raised on the body surface and transmit / receive essentially vertically through the body surface.
  • the two dark crescent-shaped areas 1 and 2 correspond to the left and right air-filled lungs genutel.
  • the path of the ultrasound signal leads from the transmitter 42 via the heart 43 through one of the lungs 1, 2 to one of the receivers 21.
  • the central point of entry or entry can also be provided on the dorsal spine or on the abdomen.
  • the belt 41 can rest on the body between the transducers 21 and thereby suppress parasitic ultrasound, especially when measured in reflection. This is understood to mean the proportion of sound that does not penetrate the body and is then reflected to the receiver, but e.g. directly from the sender to the receiver.
  • the device has a transmitter and a plurality of receivers.
  • the device can also work with one receiver and several transmitters, or with several transmitters and several receivers.
  • FIGS. 6a-6f show ultrasound signal profiles measured between different transmitters and receivers of the device shown in FIG. A broadband noise signal was always used.
  • the signal intensity is plotted in the spectra, coded by the brightness, whereby dark areas indicate a low signal intensity (corresponds to a strong beam attenuation when passing through the lungs) and bright areas indicate a high signal intensity, depending on the measuring time x-axis) and the frequency (y-axis).
  • FIG. 6a shows the signal curve as it was measured between the central transmitter 42 and the ultrasound receiver 52, FIG. 6b when measured at the receiver 56, FIG. 6c when measured at the receiver 51, and FIG. 6d recorded with the receiver 55.
  • FIG. 6e shows a spectrum that was measured in arcuate ger transmission, wherein the converter 52 works as a transmitter and the converter 54 as a receiver.
  • spectrum 6f also shows an arcuate transmission measurement with transducer 51 as transmitter and transducer 53 as receiver. During the different measurements, the ultrasound passed through different areas of the lungs.
  • the received ultrasound signal is clearly modulated in time with the breathing frequency.
  • the attenuation decreases (light areas 61)
  • the receiver only reaches a very weak signal (dark areas 62).
  • the signal modulation or useful signal dynamics is very large compared to the prior art and definitely reaches values of 30 dB.
  • the frequencies used in FIG. 6 are low-frequency ultrasound with high speed of sound. Here - close to the strong dispersion - strong resistive effects are observed, which vary greatly with the local ventilation. A sound reflection in the classic sense does not occur dominantly here.
  • the transit time or the change in the speed of sound can be measured in a manner not shown here.
  • the high speed of sound in this frequency range varies significantly with ventilation due to its proximity to the maximum dispersion.
  • the evaluation and control unit 25 can evaluate the measurements obtained, save them and display them on a display, e.g. in the representation shown in FIGS. 7a and 7b and familiar from computer tomography.
  • a specific area of the lungs can be irradiated in a targeted manner, specifically by means of a belt 41 in FIG.
  • a quasi 3-dimensional ventilation state of the lungs can be determined and dynamized in several sectional images corresponding to the three horizontal planes in which the transducers 21 are arranged from breath to breath.
  • FIG. 7a shows the lungs in the empty, Fig. 7b in the filled state.
  • the lungs are shown in three horizontal sectional planes 71, 72, 73.
  • variable display segments 74, 75, 76, 77, 78, 79 are each assigned to one of the sound paths to the receivers 51 to 56.
  • Display segment 74 e.g. corresponds to the sound path from transmitter 42 to receiver 51.
  • the display segments follow the breathing rhythm by changing their color or brightness, which corresponds to the measured sound attenuation, ie scaled with the measured sound intensity in a predetermined frequency range.
  • This representation is similar to the usual representation in computer tomography and allows the clinic staff or another operator to read the lung function intuitively.
  • the sound signal will typically no longer vary significantly in the breathing cycle and at the same time show a significantly different basic level. Such an endangered lung segment would be easy to find using this type of representation.
  • a real tomography can be achieved with the inclusion of phase-locked calculation of several receiver or transmitter signals. In a manner not shown here, the display according to FIG. received profile. This would result in a completely 3-dimensional reconstruction of the lungs.
  • real echo signals can also be used at a somewhat increased frequency of e.g. B. 50 - 150 kHz can be used for depth information and thus completely 3-dimensional reconstruction.
  • Fig. 8 shows a device for measuring lung function in training as a handheld device 81.
  • the handheld device can be used on an outpatient basis for short-term local examination of the lung.
  • the ultrasound transmitter 82 with a transmitter 42 is connected by a control and data line 83 to the main device 84, in which the control and evaluation means are accommodated.
  • the support device 85 formed on the side of the main device 84 accommodates an array of four receivers 21, only two of which are shown in the side view.
  • the support device 85 is made of a sound-absorbing material and is typically up to 20 cm in diameter.
  • a soft coupling coating 86 is provided on its contact side.
  • a display 87 which can be read from the outside, is arranged on the main device 84 for displaying the measurement results. Without the additional ultrasonic transmitter 82, e.g. also in reflection or - e.g. at lower frequency - can be measured in arcuate transmission.
  • FIGS. 9a to 9c are used to describe below how the empirically determined rhythmic changes in an ultrasound signal of the frequency according to the invention can be explained.
  • Horizontal sections through a human torso are shown.
  • the dark gray arrows represent the path of an ultrasound signal, the arrow thickness indicating the intensity of the ultrasound signal.
  • the ultrasound signal propagating in the body is indicated by dark gray arrows, the signal emerging from the body with black arrows.
  • the transmitters or receivers which rest on the outer circumferential surface of the body are omitted here for the sake of simplicity, for example they could be arranged exactly as shown in FIG. 5.
  • an ultrasound signal is radiated into the heart of a patient. From there the signal spreads radially outwards with decreasing intensity and also penetrates into the patient's two lungs. After passing through the lungs, a signal emerges from the body and can be measured by appropriate ultrasound receivers.
  • the alveolar grapes are indicated by white circles.
  • 9a shows the lungs in the exhaled state, that is to say the alveoli have a somewhat smaller diameter (exaggerated here). In practice you will have a distribution of alveolar diameters. However, the basic principle applies to all alveoli.
  • Fig. 9b the lung is shown in the inhaled state.
  • the diameter of the alveoli has increased, and with this change in size, the interaction cross section with the ultrasound signal.
  • a larger part of the irradiated signal is attenuated, for example by absorption, that is to say the signal leaving the body in FIG. 9b is of a lower intensity than in the situation outlined in FIG. 9a.
  • the above explanation applies to frequency ranges in which the interaction with filled alveoli can be found. Other frequencies, at which such an interaction with the alveoli hardly takes place, show hardly any changes when inhaling and exhaling. Changes can then result, for example, from a breath-modulated lung density.
  • FIG. 9c shows the lungs according to FIG. 9b, that is to say in the inhaled state, with a lung abnormality present in the left lung (viewed ventrally in the body direction), for example an atelectasis, which is shown as a dark gray circular area with smaller light gray circular areas arranged therein, which schematically indicate the alveoli in this area of the lungs.
  • the abnormality of this area of the lungs manifests itself by the fact that the alveoli inside are not aerated when inhaled and therefore do not change their diameter. The area remains static during breathing cycles.
  • transmitters could also be arranged where receivers are arranged, and vice versa where receivers are shown, receivers could also be arranged.
  • the measuring arrangement is reversible in principle.

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Abstract

L'invention concerne un dispositif pour mesurer le fonctionnement d'un poumon d'un corps, en particulier d'un corps humain, comprenant : un émetteur d'ultrasons qui peut être mis en contact avec le corps de manière à conduire les ultrasons, un signal ultrasonore étant formé pour être émis dans le corps par l'intermédiaire du point de contact ; un récepteur d'ultrasons qui peut être mis en contact avec le corps de manière à conduire les ultrasons, un signal ultrasonore de réception étant formé par l'intermédiaire du point de contact, et ; un dispositif d'évaluation et de commande qui sert à commander l'émetteur d'ultrasons ainsi qu'à recevoir et à évaluer un signal généré par le récepteur d'ultrasons. Cette invention est caractérisée en ce que le dispositif est conçu pour fonctionner dans une gamme de fréquences comprise entre 5 et 1000 kHz, ou une gamme partielle de ladite gamme de fréquences.
PCT/EP2005/001145 2004-02-05 2005-02-04 Dispositif pour mesurer le fonctionnement d'un poumon WO2005074809A1 (fr)

Priority Applications (1)

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DE112005000234T DE112005000234A5 (de) 2004-02-05 2005-02-04 Vorrichtung zur Messung der Funktion einer Lunge

Applications Claiming Priority (6)

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DE202004001776.8 2004-02-05
DE200420001776 DE202004001776U1 (de) 2004-02-05 2004-02-05 Vorrichtung zur kontinuierlichen Überwachung der lokalen Lungenventilation
DE202004002930U DE202004002930U1 (de) 2004-02-23 2004-02-23 Vorrichtung zur übersichtlichen und ortsauflösenden Darstellung der Lungenventilation
DE202004002930.8 2004-02-23
DE202004006536.3 2004-04-22
DE200420006536 DE202004006536U1 (de) 2004-04-22 2004-04-22 Vorrichtung zur vorteilhaften Gewinnung von Informationen zur lokalen Lungenventilation mit akustischen Methoden

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102007014108A1 (de) 2007-03-21 2008-09-25 Rüter, Dirk, Dr.-Ing. Patientenliege zur Verbesserung einer bildgebenden Ultraschall-Darstellung des Thoraxinneren
FR2944199A1 (fr) * 2009-04-14 2010-10-15 Arnaud Alexandre Boudousse Monitorage de l'accolement pleural pulmonaire physiologique par velocimetrie doppler a emission pulse
EP2277452A1 (fr) * 2009-07-23 2011-01-26 Siemens Schweiz AG Dispositif de guidage d'ultrasons
WO2012052824A1 (fr) * 2010-10-21 2012-04-26 Palti Yoram Prof Mesure de la pression sanguine pulmonaire au moyen d'une échographie doppler pulmonaire transthoracique

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5588439A (en) * 1995-01-10 1996-12-31 Nellcor Incorporated Acoustic impulse respirometer and method
WO2002022017A1 (fr) * 2000-09-15 2002-03-21 Friendly Sensors Ag Procede et dispositif de production de donnees de mesure relatives a la respiration
WO2002094089A2 (fr) * 2001-05-19 2002-11-28 Niels Kristian Kristiansen Methode et dispositif d'enregistrement du volume de la vessie
US6585647B1 (en) * 1998-07-21 2003-07-01 Alan A. Winder Method and means for synthetic structural imaging and volume estimation of biological tissue organs
US20040015059A1 (en) * 2000-04-19 2004-01-22 Arnd Friedrichs Devices and method for producing measuring data relating to the movements of the abdominal wall

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5588439A (en) * 1995-01-10 1996-12-31 Nellcor Incorporated Acoustic impulse respirometer and method
US6585647B1 (en) * 1998-07-21 2003-07-01 Alan A. Winder Method and means for synthetic structural imaging and volume estimation of biological tissue organs
US20040015059A1 (en) * 2000-04-19 2004-01-22 Arnd Friedrichs Devices and method for producing measuring data relating to the movements of the abdominal wall
WO2002022017A1 (fr) * 2000-09-15 2002-03-21 Friendly Sensors Ag Procede et dispositif de production de donnees de mesure relatives a la respiration
WO2002094089A2 (fr) * 2001-05-19 2002-11-28 Niels Kristian Kristiansen Methode et dispositif d'enregistrement du volume de la vessie

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102007014108A1 (de) 2007-03-21 2008-09-25 Rüter, Dirk, Dr.-Ing. Patientenliege zur Verbesserung einer bildgebenden Ultraschall-Darstellung des Thoraxinneren
FR2944199A1 (fr) * 2009-04-14 2010-10-15 Arnaud Alexandre Boudousse Monitorage de l'accolement pleural pulmonaire physiologique par velocimetrie doppler a emission pulse
EP2277452A1 (fr) * 2009-07-23 2011-01-26 Siemens Schweiz AG Dispositif de guidage d'ultrasons
WO2011009744A3 (fr) * 2009-07-23 2011-05-26 Siemens Schweiz Ag Dispositif de guidage d'ultrasons
WO2012052824A1 (fr) * 2010-10-21 2012-04-26 Palti Yoram Prof Mesure de la pression sanguine pulmonaire au moyen d'une échographie doppler pulmonaire transthoracique
US8968203B2 (en) 2010-10-21 2015-03-03 Echosense Inc. Measuring pulmonary blood pressure using transthoracic pulmonary doppler ultrasound

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