EP0977512A1

EP0977512A1 - Medical imaging device and associated method

Info

Publication number: EP0977512A1
Application number: EP98918618A
Authority: EP
Inventors: Peter J. Wilk
Original assignee: Wilk Patent Development Corp
Current assignee: Wilk Patent Development Corp
Priority date: 1997-04-24
Filing date: 1998-04-23
Publication date: 2000-02-09
Also published as: AU7151398A; CA2287386A1; AU748589B2; JP2002511781A; WO1998047428A1

Abstract

A medical imaging system includes a video screen which is juxtaposable closely to a patient and an ultrasonic scanner for generating the images of internal organic tissues of the patient. The video screen may be a flexible screen on a flexible substrate or, alternatively, one of a plurality of screens disposed on respective pads or plates hinged to one another. Holes are provided in the video screen or between adjacent screens for enabling insertion of a medical instrument into the patient.

Description

MEDICAL IMAGING DEVICE AND ASSOCIATED METHOD

Background of the Invention

This invention relates to an imaging device or system. The imaging device or system is

especially useful as a medical system More particularly, this invention relates to a device or

system which determines three-dimensional shapes of objects such as internal organs of a patient preferably by using ultrasonic pressure waves This invention also relates to a method

useful in medical operations

In recent years, the escalation of medical costs has captured substantial media and

regulatory attention One reason for the escalating costs is the ever increasing use of

expensive machines and testing techniques Computed assisted tomography (CAT scanning),

magnetic resonance imaging (MRI) and some radiological techniques have been in the

forefront of contributing to mounting medical costs In addition to being expensive, these devices are heavy and bulky, making them ill suited to transport

In this age of rapidly escalating medical costs, minimally invasive operations have

become the method of choice for diagnosis and treatment In many cases, endoscopic,

laparoscopic and radiographic techniques have superseded older diagnostic and therapeutic

surgical techniques

Summary of the Invention

An object of the present invention is to provide an imaging device or system which is

relatively inexpensive and easy to transport

It is another object of the present invention to provide an alternative to conventional

medical imaging systems

A further object of the present invention is to provide a medical imaging system which exhibits reduced costs over conventional imaging systems such as CAT scanners and MRI

machines.

A particular object of the present invention is to provide a medical imaging system

which can be used during the performance of so-called minimally invasive medical operations. It is an additional object of the present invention to provide a medical imaging system which is portable.

Another object of the present invention is to provide a medical operating method which provides real time imaging in a cost effective manner.

These and other objects of the present invention, which will be apparent from the

drawings and descriptions herein, are attained in a medical imaging device comprising a flexible

web conformable to a patient, at least one electroacoustic transducer attached to the web, an a-

c current source being operatively connected to the transducer for energizing the transducer

with an electrical signal of a pre-established ultrasonic frequency to produce a first pressure

wave. At least one acoustoelectric transducer is attached to the web, while an analyzing

component is operatively connected to the acoustoelectric transducer for determining three-

dimensional shapes of internal organs of the patient by analyzing signals generated by the

acoustoelectric transducer in response to second pressure waves produced at internal organs of

the patient in response to the first pressure wave. The web is provided with at least one

aperture permitting traversal of the web by a medical instrument so that a distal end of said

medical instrument lies inside the patient while said carrier is disposed adjacent to a skin

surface of the patient.

According to a feature of the invention, a video monitor is linked to the analyzing

component for displaying an image of the internal organs. Although stereoscopic (3-D) medical viewing systems have been introduced, it is contemplated that the image will generally

be a two-dimensional image Accordingly, the system preferentially includes a view selector

operatively connected to the analyzing component and the video monitor for selecting the

image from among a multiplicity of possible images of the internal organs. In addition, a filter

stage may be operatively connected to the analyzing component and the video monitor for

eliminating a selected organ from the image In one example of the use of the filter, blood moving through a vessel of the vascular system is deleted to enable viewing of the blood vessel

walls on the monitor

The web may be provided with a plurality of electroacoustic transducers attached to the web in a predetermined array In that event, the system further comprises circuitry for

energizing the electroacoustic transducers in a predetermined sequence Where the web carries

a plurality of acoustoelectric transducers attached to the web in a predetermined array, the

system further comprises circuit components for receiving signals from the acoustoelectric

transducers in a predetermined sequence

In accordance with another feature of the present invention, the web is provided with a

plurality of apertures each enabling traversal of the web by a medical instrument. Thus, the

system may be used for performing a complex diagnostic or surgical operation.

The web may be provided with at least one chamber for holding a fluid. The

transducers are disposed in ultrasonic or pressure-wave communication with the chamber,

thereby facilitating pressure wave transmission from the electroacoustic transducer to the

patient and from the patient to the acoustoelectric transducer

The web may take the form of a garment such as a vest surrounding the chest region or

a girdle surrounding the abdominal region A method for performing a medical operation, in accordance with the present

invention, utilizes a medical instrument and flexible web conformable to a patient, the web also

having at least one electroacoustic transducer and at least one acoustoelectric transducer

attached to the web. The web is disposed adjacent to a skin surface of the patient so that the web is in acoustic or pressure-wave-transmitting contact with the skin surface. A distal end of

the medical instrument is inserted into the patient so that the distal end is disposed inside the

patient while the web is disposed adjacent to the skin surface. After disposition of the web

adjacent to the skin surface, the electroacoustic transducer is energized with an electrical signal

of a pre-established ultrasonic frequency to produce a first pressure wave. Signals generated

by the acoustoelectric transducer in response to second pressure waves produced at internal organs of the patient and at the distal end of the medical instrument in response to the first

pressure wave are automatically analyzed to thereby determine three-dimensional shapes of the

internal organs of the patient and a location of the distal end of the medical instrument relative

to the internal organs, thereby enabling a real time manipulation of the instrument to effectuate

a medical operation on a selected one of the internal organs.

It is contemplated that a video image will be generated of the patient's internal organs

and the distal end of the medical instrument in response to the analysis of signals generated by

the acoustoelectric transducer.

Preferably, the distal end of the medical instrument is inserted into the patient after the disposition of the web in contact with the patient's skin surface. Then, the insertion of the

instrument into the patient can be guided in response to real-time three-dimensional structural

data on the relative locations of the instrument and the internal organs of the patient.

Where the web has a plurality of apertures, the medical instrument may be passed into the patient through one of the apertures. In this way, laparoscopic surgery as well as other

invasive operations, whether diagnostic or therapeutic, may be performed with the aid of realtime visual images produced upon the analysis of returning ultrasonic pressure waves. Laparoscopic surgery is simplified by eliminating the need for a laparoscope. Laparoscope

elimination enables a reduction in the number of perforations made in the patient or,

alternatively, enables the insertion of another laparoscopic instrument with the same number of

perforations.

Multitudinous operations are facilitated with the use of ultrasonically derived images of

internal organic structures. Such operations include liver biopsies, kidney biopsies, and pleural

biopsies and the placement of tubular members, including drains and catheters, for such

techniques as thoracentesis and abscess drainage and further include diagnostic operations now performed by using a flexible endoscope.

Where the web carries a plurality of electroacoustic transducers attached to the web in a predetermined array, the method further comprises energizing the electroacoustic transducers

in a predetermined sequence. Where the web carries a plurality of acoustoelectric transducers

attached to the web in a predetermined array, the method further comprises receiving signals

from the acoustoelectric transducers in a pre-established sequence.

In accordance with an additional feature of the present invention, a printed image of the

internal organs is generated in response to the analysis of signals generated by the

acoustoelectric transducer. This printed image facilitates diagnosis by providing a quick and

safe image.

Diagnosis is further facilitated by generating an electrical signal encoding the

determined three dimensional shapes of the internal organs and wirelessly transmitting the additional signal to a remote location. Thus, consultations with experts are possible from

remote locations.

It is to be noted in this regard that an ultrasonic imaging device in accordance with the present invention is portable, at least significantly more portable than conventional imaging systems such as CAT scanners and MRI machines. Thus, imaging, diagnosis and treatment is

possible even where patients do not have ready access to a hospital facility. The images may

be transmitted from remote locations to global medical centers where experts can view the internal structures for diagnosis and therapeutic evaluation.

The above-related and other objects of the present invention are also attained in a

medical imaging device comprising a container assembly defining a fluid- or liquid-filled

chamber. The container assembly includes a flexible wall or panel which is conformable to a

patient. The container assembly has at least one electroacoustic transducer in operative

contact with the fluid-filled chamber so as to produce pressure waves in the fluid disposed in

the chamber of the container assembly. An a-c current source is operatively connected to the transducer for energizing the transducer with an electrical signal of a pre-established ultrasonic

frequency to produce a first pressure wave in the fluid in the chamber. The container assembly

is further provided with at least one acoustoelectric transducer which is in operative contact

with the fluid-filled chamber for detecting or picking up pressure waves in the fluid in the

chamber. An analyzing component is operatively connected to the acoustoelectric transducer

for determining three-dimensional shapes of internal organs of the patient by analyzing signals

generated by the acoustoelectric transducer in response to second pressure waves produced at

internal organs of the patient in response to the first pressure wave and transmitted through the

fluid in the chamber. Preferably, the container assembly includes a bag or bladder defining the fluid-filled

chamber and further includes a plurality of substantially rigid walls or panels which partially

surround and support the bag. The patient is placed on the fluid-filled bag, the upper surface

of which is the flexible wall. The flexible wall deforms to receive and cradle the patient and is

preferably coated with a liquid to facilitate ultrasonic pressure wave transfer between the

patient and the bag.

A flexible web or sheet may be placed over the patient after disposition of the patient on the fluid-filled bag. The web or sheet may itself be provided with an ultrasonic

electroacoustic and/or acoustoelectric transducer. Where the medical system is to be used in

performing surgical operations under real-time visual feedback provided via ultrasonic wave

generation, detection and analysis componentry, the web or cover sheet is preferably provided

with a plurality of apertures enabling traversal of the web or sheet by elongate medical

instruments, such as biopsy instruments or elongate instruments traditionally used in

laparoscopic surgery.

Again, a video monitor is linked to the analyzing component for displaying an image of

the internal organs, while a view selector is operatively connected to the analyzing component

and the video monitor for selecting the image from among a multiplicity of possible images of

the internal organs. In addition, a filter stage may be operatively connected to the analyzing

component and the video monitor for eliminating a selected organ from the image.

It is contemplated generally that acoustoelectric and electroacoustic transducers are

disposed in or attached to the rigid walls or panels. However, the transducers may be attached

to or embedded in one or more flexible walls of the fluid-filled chamber. Specifically, some of

the transducers may be attached to or embedded in the flexible upper wall of the fluid-filled chamber which conforms to and engages the patient.

With the patient received by the fluid-filled bag and covered by the flexible web or sheet, ultrasonic transducers may be disposed in an array virtually surrounding the patient.

This disposition of transducers provides a dense stream of organ position and configuration

data to the analyzing component, thereby facilitating an enhancement of image resolution and

the provision of multiple view angles.

The ultrasonic transducers may be disposed in a separate pad disposed, for example, beneath the fluid-filled bag prior to the placement of the patient on the bag.

A method for performing a medical operation, in accordance with the present

invention, utilizes a medical instrument and container assembly which defines a fluid-filled chamber having a flexible wall which is conformable to a patient. The container assembly is

provided with at least one electroacoustic transducer and at least one acoustoelectric transducer which are in operative contact with the fluid-filled chamber so as to respectively

generate and detect ultrasonic waves in the fluid. The flexible wall of the fluid-filled chamber

is disposed adjacent to a skin surface of the patient so that the chamber is in acoustic or

pressure-wave-transmitting contact with the skin surface. A distal end of the medical

instrument is inserted into the patient so that the distal end is disposed inside the patient while

the fluid-filled chamber is disposed adjacent to the skin surface. After disposition of the

container assembly adjacent to the skin surface, the electroacoustic transducer is energized

wave in the fluid in the chamber and accordingly in the patient. Signals generated by the

the patient and at the distal end of the medical instrument in response to the first pressure wave are automatically analyzed to thereby determine three-dimensional shapes of the internal organs of the patient and a location of the distal end of the medical instrument relative to the internal organs, thereby enabling a real time manipulation of the instrument to effectuate a medical operation on a selected one of the internal organs.

An imaging device comprises, in accordance with the present invention, a flexible

substrate, a flexible video screen disposed on the substrate, and a scanner operatively

connected to the video screen for providing thereto a video signal encoding an image of

objects located near the substrate. The scanner is preferably provided with an analyzing

component, generally a specially programmed digital computer, for analyzing scanner sensor

signals and determining therefrom three-dimensional shapes of the objects.

This imaging device is considered to be particularly advantageous in medical diagnosis

and treatment procedures. The substrate with the video screen is disposed on a selected body

portion of a patient, for example, the abdomen or a shoulder or knee, so that the substrate and

the video screen substantially conform to the selected body portion and so that the video

screen is facing away from the body portion. After the disposition of the substrate and the

video screen on the selected body portion of the patient, the scanner is operated to provide a

video signal to the video screen, the video signal encoding an image of internal organs of the

patient. Preferably, the video screen is operated to reproduce the image so that internal organ

representations as displayed on the video screen substantially overlie respective corresponding

actual organs of the patient. Thus, for many purposes and applications, it appears to the user

(generally a physician) that he or she is able to see through the skin and other overlying tissues

to selected underlying organs.

To enable or facilitate an alignment of the displayed organ representations and the respective underlying actual organs, it is recommended that markers be placed in prespecified

locations on the patient The markers are easily recognized by the analyzing computer and

serve to define a reference frame whereby the position and orientation of the video screen

relative to the patient's internal organs is detectable Accordingly, the position and orientation of each portion or area of the video screen relative to the internal organs of the patient is determined to enable the display on the video screen of images of organs underlying the

different portions of the screen Where the screen is folded back on itself in conforming to a

curved skin surface of the patient, two or more overlapping screen areas may be provided with

the same image signal However, only the uppermost screen portion of the overlapping areas

will be visible to the user

The imaging device or system is preferably provided with a number of ancillary

components or functional subcomponents for facilitating use of the system as a medical

diagnostic and therapeutic tool For example, the analyzing component may include a module,

typically realized as a programmed general computer circuit, for highlighting a selected feature

of the internal organs of the patient The highlighting may be implemented by changing the

color or intensity of the selected feature relative to the other features in the displayed image,

thus providing a visual contrast of the selected feature with respect to the other features of the

displayed image An intensity change may be effectuated by essentially blacking or whiting out

the other portions of the image so that the selected feature is the only object displayed on the

video screen

Another ancillary component for enhancing the usefulness of the imaging device or

system is voice-recognition circuitry operatively connected to the analyzing computer Voice

recognition circuity is especially beneficial for medical applications in that doctors must frequently have their hands (and even feet) available for operating medical equipment. In

conventional medical procedures, voice control is exerted via attendant personnel: the

assistants are requested by the lead physician to perform desired tasks. The voice recognition

circuitry of the present invention is used, for instance, to request highlighting of a selected

organ or removal of an organ from the image on the video screen. The removal of selected

organs or tissues enables the user to view underlying organs. Viewing of the patient's internal structures may thus proceed in an ever more deeply penetrating sequence, with successive

removal of different layers of tissues.

Yet another ancillary component is speech synthesis circuitry operatively connected to the analyzing computer. The voice recognition and speech synthesis circuitry together enable

the user to interface with the imaging device as if the device were an operating room assistant.

These ancillary components also free the physician's eyes to look at the flexible video screen.

The analyzing computer's tasks may extend well beyond normal image analysis and

construction. The computer may be programmed for automated diagnosis based on pattern

recognition. For example, the computer may be programmed to recognize a bloated appendix

by comparing the image data with prestored data identifying normal and inflamed appendices.

The computed diagnosis may be communicated to the physician via the speech synthesis

circuitry: "Enlarged appendix— possible appendicitis— recommend immediate removal."

The substrate and the video screen are advantageously provided with a plurality of

mutually aligned apertures enabling traversal of the substrate and the video screen by medical

instruments. The distal ends of the medical instruments, inserted into the patient in the field of

view of the imaging system, are displayed on the video screen together with the selected

internal organs of the patient. In this way, laparoscopic surgery as well as other invasive operations, whether diagnostic or therapeutic, may be performed with the aid of real-time

visual images of the patient's internal organs displayed on the flexible video screen. Laparoscopic surgery is simplified by eliminating the need for a laparoscope. Laparoscope

perforations. Other operations implemented by inserting instruments through the flexible video

screen include liver biopsies, kidney biopsies, and pleural biopsies and the placement of tubular

members, including drains and catheters, for such techniques as thoracentesis and abscess

drainage. An additional ancillary component for enhancing the usefulness of the imaging device or system in accordance with the present invention is a transceiver interface for operatively

connecting the scanner, including the analyzing computer, to a long-distance

telecommunications link. The image data is transmitted over the telecommunications link to a

video monitor at a remote location, thereby enabling observation of the patient's internal

organs by specialists in distant cities. These specialists may provide diagnostic and treatment

advice to people in the location of the patient. Also, a surgical procedure may be exerted

robotically under the control of the distant experts, as disclosed in U.S. Patents Nos. 5,217,003

and 5,217,453 to Wilk.

In accordance with a principal embodiment of the present invention, the scanner utilizes

ultrasonic pressure waves to collect the three-dimensional structural data from which the organ

images are derived or constructed. Such an ultrasonic scanner includes at least one

electroacoustic transducer, an a-c current generator operatively connected to the transducer

for energizing the transducer with an electrical signal of a pre-established ultrasonic frequency to produce a first pressure wave, and at least one acoustoelectric transducer. The analyzing

computer is operatively connected to the acoustoelectric transducer for determining three- dimensional shapes of the objects by analyzing signals generated by the acoustoelectric transducer in response to second pressure waves produced at the objects in response to the first pressure wave.

In a particular embodiment of the invention, at least one of the ultrasonic transducers is

mounted to the substrate. Typically, the electroacoustic transducer is one of a plurality of

electroacoustic transducers and the acoustoelectric transducer is one of a plurality of

acoustoelectric transducers, all mounted to the substrate. This configuration is especially portable: it is compact and lightweight.

In accordance with another embodiment of the present invention, a medical imaging

device comprises a planar substrate, a substantially flat video screen provided on the substrate, a flexible bag connected to the substrate, and a scanner operatively connected to the video

screen for providing a video signal thereto. The bag is disposed on a side of the substrate

opposite the video screen and is filled with a fluidic medium capable of transmitting ultrasonic

pressure waves. The video signal encodes an image of internal tissues of a patient upon

placement of the flexible bag with the medium, the substrate and the video screen against the

patient.

An imaging device comprises, in accordance with another embodiment of the present

invention, a plurality of substantially planar substrates, at least one flexible connection coupling

the substrates to one another so that the substrates are extendable at a variable angle with

respect to one another, a plurality of video screens each attached to one of the substrates, and

a scanner operatively connected to the video screens for providing respective video signals thereto, the video signals each encoding an image of objects located near a respective one of

the substrates.

It is contemplated that the scanner is an ultrasonic scanner and includes at least one

electroacoustic transducer and at least one acoustoelectric transducer. Where a flexible bag filled with a fluidic medium is attached to the substrate or substrates, the transducers are both attached at least indirectly to the substrate(s) so that ultrasonic pressure waves can travel

through the fluidic medium from the electroacoustic transducer and to the acoustoelectric

transducer.

The scanner is preferably provided with an analyzing component, generally a specially

programmed digital computer, for analyzing scanner sensor signals and determining therefrom

three-dimensional shapes of objects being scanned.

The imaging device of the present invention is considered to be particularly

advantageous in medical diagnosis and treatment procedures. The substrate or substrates with

one or more video screens are disposed on a selected body portion of a patient, for example,

the abdomen or a shoulder or knee, so that the substrate and the video screen overlie the

selected body portion and so that the video screen or screens are facing away from the body

portion. After the disposition of the substrate and the video screen, or the multiple substrates

and the multiple video screens next to the patient, the scanner is operated to generate one or

more video signals and transmit those signals to the video screens. The video signals encode

images of internal tissues of the patient. Preferably, the video screens are operated to

reproduce the images so that representations of internal tissues (e.g., organs) as displayed on

the video screens substantially overlie respective corresponding actual tissues (organs) of the

patient. Thus, for many purposes and applications, it appears to the user (generally a physician) that he or she is able to see through the skin and other overlying tissues to selected

underlying tissues.

To enable or facilitate an alignment of the displayed tissue representations and the

respective underlying actual tissues, it is again recommended that markers be placed in

prespecified locations on the patient. Also, the imaging device or system is preferably

provided with a number of ancillary components or functional subcomponents for facilitating

use of the system as a medical diagnostic and therapeutic tool. For example, the analyzing component may include a module for highlighting a selected feature of the internal organs of

the patient, voice-recognition circuitry, speech synthesis circuitry, computer implemented

diagnosis, and a telecommunications transceiver

Where the imaging device comprises multiple video screens, the device is

advantageously provided with a plurality of apertures, for example, in the interstitial spaces between the video screens, enabling traversal of the device by medical instruments. The distal

ends of the medical instruments, inserted into the patient in the field of view of the imaging

system, are displayed on the video screens together with internal target tissues of the patient.

In this way, laparoscopic surgery as well as other invasive operations, whether diagnostic or

therapeutic, may be performed with the aid of real-time visual images of the patient's internal tissues displayed on the video screens. Laparoscopic surgery is simplified by eliminating the

need for a laparoscope. Laparoscope elimination enables a reduction in the number of

perforations made in the patient or, alternatively, enables the insertion of another laparoscopic

instrument with the same number of perforations. Other operations implemented by inserting

instruments through the flexible video screen include liver biopsies, kidney biopsies, and pleural

biopsies and the placement of tubular members, including drains and catheters, for such techniques as thoracentesis and abscess drainage

In a particular embodiment of the invention, at least one of the ultrasonic transducers is mounted to the substrate or to one of the substrates Typically, the electroacoustic transducer

is one of a plurality of electroacoustic transducers and the acoustoelectric transducer is one of

a plurality of acoustoelectric transducers, all mounted to the substrate or substrates. This

configuration is especially portable: it is compact and lightweight.

Where the imaging device is used to diagnose or treat a limb or a joint, the planar

substrates and the video screens attached thereto have sizes and possibly shapes which facilitate substantial conformity with the limb or joint

A medical method in accordance with the present invention utilizes an imaging device including a plurality of planar substrates fastened to one another by flexible connectors, each of the substrates carrying a respective video screen, a scanner being operatively connected to the

video screens Pursuant to the method, the substrates with the video screens are disposed on a

body portion of a patient so that the substrates and the video screens substantially conform to

the body portion of the patient and so that the video screens are facing away from the body

portion of the patient After the disposition of the substrates and the video screens on the body

portion of the patient, the scanner is operated to provide video signals to the video screens, the

video signals encoding images of internal tissues of the patient.

Preferably, the video screens are operated to reproduce the images so that internal

tissue representations as displayed on the video screens substantially overlie respective corresponding actual tissues of the patient

The method also contemplates the placing of markers on the patient for facilitating the

reproducing of the images so that the internal tissue representations on the video screens substantially overlie respective corresponding actual tissues of the patient.

Brief Description of the Drawings

Fig. 1 is a block diagram of a medical diagnostic system, which may utilize or

incorporate an ultrasonographic imaging device in accordance with the present invention. Fig. 2 is a flow-chart diagram illustrating steps in a mode of operation of the diagnostic

system of Fig. 1.

Fig. 3 is a flow-chart diagram illustrating steps in another mode of operation of the

diagnostic system of Fig. 1.

Fig. 4 a block diagram of a further medical diagnostic system.

Fig. 5 is a diagram showing the composition of a data string or module used in the

system of Fig. 4.

Fig. 6 is a block diagram of a computerized slide scanning system.

Fig. 7 is a block diagram of a device for measuring a diagnostic parameter and

transmitting the measurement over the telephone lines.

Fig. 8 is a diagram of an ultrasonography device

Fig. 9 is a diagram showing a modification of the device of Fig. 8.

Fig. 10 is a block diagram of an ultrasonographic imaging apparatus similar to the

device of Figs. 8 and 9, for use in diagnostic and therapeutic procedures.

Fig. 1 1 is a block diagram showing a modification of the apparatus illustrated in Fig.

10.

Fig. 12 is partially a schematic perspective view and partially a block diagram showing

use of an ultrasonographic imaging device in a minimally invasive diagnostic or therapeutic

procedure. Fig. 13 is a partial schematic perspective view including a block diagram showing use

of an ultrasonographic imaging device in another minimally invasive diagnostic or therapeutic

procedure.

Fig. 14 is a schematic perspective view of yet another ultrasonographic imaging device which includes a sensor vest in a closed, use configuration.

Fig. 15 is a schematic perspective view of the sensor vest of Fig. 14, showing the vest in an open configuration.

Fig. 16 is partially a schematic perspective view and partially a block diagram of an

ultrasonic diagnostic imaging device.

Fig. 17 is partially a schematic perspective view and partially a block diagram of the

ultrasonic diagnostic imaging device of Fig. 16, showing the device in use with a patient.

Fig. 18 is partially a schematic perspective view and partially a block diagram of

another ultrasonic diagnostic imaging device, showing the device in use with a patient.

Fig. 19 is partially a schematic perspective view and partially a block diagram of the

ultrasonic diagnostic imaging device of Figs. 17 and 18, showing a modification of the device

of those figures.

Fig. 20 is partially a schematic exploded perspective view and partially a block diagram

of an ultrasonographic device or system related to the present invention.

Fig. 21 is a schematic perspective view showing use of the system of Fig. 20 in

performing a laparoscopic operation.

Figs. 22A and 22B are schematic perspective views showing use of another

ultrasonographic device related to the present invention.

Fig. 23 A is a schematic perspective view of a further ultrasonographic device related to the present invention.

Fig. 23B is a schematic perspective view showing use of the ultrasonographic device of

Fig. 23 A.

Fig. 24 is a schematic perspective view of an ultrasonographic device in accordance with the present invention.

Fig. 25 is a schematic perspective view of another ultrasonographic device in accordance with the present invention.

Fig. 26 is a schematic perspective view of the ultrasonographic device of Fig. 25,

showing the device in use on a patient.

Fig. 27A is a schematic front elevational view of a video screen display configuration

utilizable in the ultrasonographic device of Figs. 25 and 26.

Fig. 27B is a schematic front elevational view of a further video screen display

configuration utilizable in the ultrasonographic device of Figs. 25 and 26.

Fig. 28 is a schematic partial perspective view of a modification of the ultrasonographic

device of Figs. 25 and 26, showing a mode of use of the device in a surgical treatement or a

diagnostic procedure.

Description of the Preferred Embodiments

The present invention is directed chiefly to an imaging device and particularly to an

ultrasonographic imaging device utilizable in diagnostic and therapeutic procedures. The

ultrasonographic imaging device of the present invention is described generally hereinafter with

reference to Figs. 8 et seq. and particularly with reference to Figs. 20 et seq. The

ultrasonographic imaging device, and particularly image derivation or construction portions

thereof, can be employed as an image generating apparatus or scanner 42 in the medical diagnostic system of Fig. 1 or a diagnostic image generating apparatus 78a, 78b, 78i in the

medical diagnostic system of Fig. 4. Alternatively or additionally, the ultrasonographic

imaging device can be employed in carrying out certain minimally invasive diagnostic or

therapeutic operations, examples of which are illustrated schematically in Figs. 12 and 13.

As illustrated in Fig. 1, a medical diagnostic system comprises a device 20 for

monitoring and measuring a biological or physiological parameter. Monitoring and measuring

device 20 is juxtaposable to a patient for collecting individualized medical data about the

patient's condition. Device 20 may take the form of an electronic thermometer, an electronic blood pressure gauge, a pulmonary function apparatus, a Doppler study apparatus, an EEG machine, an EKG machine, an EMG machine, or a pressure measurement device, etc., or include a plurality of such components.

Monitoring and measuring device 20 is connected at an output to a digitizer 22 which

converts normally analog type signals into coded binary pulses and transmits the resulting

digital measurement signal to a computer 24. Digitizer 22 may be incorporated into a housing

(not shown) enclosing all or part of the monitoring and measuring device 20. Moreover,

digitizer may be an integral part of monitoring and measuring device 20.

Computer 24 receives instructions and additional input from a keyboard 26. Keyboard

26 is used to feed computer 24 information for identifying the patient, for example, the

patient's age, sex, weight, and known medical history and conditions. Such medical conditions may include past diseases and genetic predispositions.

Computer 24 is also connected to an external memory 28 and an output device 30 such

as a printer or monitor. Memory 28 stores medical data for a multiplicity of previously

diagnosed medical conditions which are detectable by analysis of data provided by monitoring and measuring device 20.

As illustrated in Fig. 2, monitoring and measuring device 20 detects a magnitude of a predetermined biological or physiological parameter in a step 32. Digitizer 22 converts the detected magnitude into a pre-established digital format in a step 34 and transmits the digital signal to computer 24 in a step 36. Computer 24 is operated in a step 38 to compare the

digitized data from monitoring and measuring device 20 with the data stored in memory 28 and

to derive a diagnosis as to the patient's condition. The diagnosis is then communicated to the

user (operator) and to the patient via output device 30 in a step 40.

If monitoring and measuring device 20 measures a physiological function characterized

by a plurality of different variables, for example, the electric potential at different points on the

patient's body (EEG, EKG, EMG), these variables may be broken down by computer 24 into

one or more parameters, e.g., a frequency packet. The measured values of the pre-established parameters are then compared with parameter ranges stored in memory 28 for the type of

parameter and the kind of patient, as characterized by sex, age, weight, etc. If the measured

values of the pre-established parameters fall within expected ranges, as stored in memory 28,

then computer 28 communicates a "normalcy" finding via printer 30. If, on the contrary, the

measured values of one or more parameters fall outside the normal ranges, then a diagnosis of

a possible medical condition is printed out.

As further illustrated in Fig. 1 , the medical diagnostic system may comprise, in addition

to or alternatively to monitoring and measuring device 20, image generating apparatus or

scanner 42 for generating in electrically encoded form a visually readable image of an organic

part of the patient. Scanner 42 may take the form of an MRI apparatus, a CAT scanner, an

X-ray machine, an ultrasonography apparatus (see Figs. 8-15 and 20), or a video camera with or without magnification optics for magnifying a sample on a slide. The video camera can be

used for obtaining an image of a portion of a patient's skin.

Scanner 42 is connected via an interface 44 to computer 24.

As shown in Fig. 3, scanner 42 obtains an image of a tissue or organ in a step 46. The

image is digitized, either by scanner 42 or interface 44 in a step 48, and is transmitted to computer 24 in a step 50. Computer 24 is operated in a step 52 to analyze the image from

scanner 42 and determine specific values for a multiplicity of predetermined parameters. For

example, in the event that scanner 42 takes the particular form of a video camera for

dermatological diagnosis, an image of a skin surface of a patient is analyzed by computer 24 to

derive such parameters as percentage of skin covered by abnormal condition, the range of sizes

of individual ulcers, the range of color variation (e.g., whether bleeding is symptomatic).

The specific values of pre-established parameters calculated by computer 24 from electrically encoded images transmitted from scanner 42 are compared by computer 24 with

previously determined parameter ranges stored in memory 28. For example, if a pregnant woman's fetus is being scanned by ultrasonography, the lengths of the fetal appendages, arms,

legs, fingers, etc., are compared with each other and with respective fetal appendage ranges

recorded in memory 28 for the stage of pregnancy, weight of the fetus, and possibly weight of

the mother. In the event that any appendages are missing or are of abnormal length, a

diagnosis as to possible deformity is printed out. Organs internal to the fetus may be similarly

examined automatically by scanner 42 and computer 24. In more advanced stages of

pregnancy, physiological functions such as the heart rate of the fetus may be automatically

monitored for abnormal conditions.

The analysis performed by computer 24 on the image from scanner 42 will depend in part on the region of the patient's body being scanned. If a woman's breast or a person's cortex

is being monitored for tumorous growths, computer 24 is programmed to separate the tissue

image into regions of different textures. The different textured regions are parameterized as to

size, shape and location and the derived parameters are compared to values in memory 30 to

determine the presence of a tumor. Additional analysis is undertaken to detect lines in an

image which may indicate the presence of an organic body.

A similar analysis is undertaken to evaluate a tissue specimen on a slide. The texture and line scanning may be repeated at different magnification levels if, for example, the tissue

sample is a slice of an organ wall. On a high magnification level, the texture and line analysis

can serve to detect microorganisms in blood.

Memory 28 may store entire images related to different diseases. For example,

memory may store images of skin conditions in the event that scanner 42 takes the form of a

video camera at a dermatological diagnosis and treatment facility. In a step 54 (Fig. 3),

computer 24 compares the image of a patient's skin with previously stored images in memory

28, for example, by breaking down the current image into sections and overlaying the sections with sections of the stored images, at variable magnification levels.

In the event that scanner 42 takes the form of an MRI apparatus, a CAT scanner or an

ultrasonographic scanner such as those described hereinafter with references to Figs. 8-15 and

20, the images stored in memory 28 are of internal organic structures. In step 54 (Fig. 3),

computer 24 compares images of a person's internal organs with previously stored organ

images in memory 28. Computer 24 partitions the image from the MRI apparatus or CAT

scanner into subareas and overlays the subareas with sections of the stored images, at variable

magnification levels. In a final step 40 (Fig. 3), computer 24 communicates the results of its diagnostic

evaluation to a user or patient.

As illustrated in Fig. 4, a medical diagnostic system comprises a plurality of remote

automated diagnostic stations 60a and 60b connected via respective telecommunications links

62a and 62b to a central computer 64. Each diagnostic station 60a, 60b may take the form

shown in Fig. 1, local computer 24 communicating via link 62a, 62b with central computer 64.

Alternatively, each diagnostic station 60a, 60b may take the form shown in Fig. 4 and include a

respective plurality of monitoring and measuring devices 66a, 66b, ... 66n operatively

connected to a local computer 68 via respective digitizer output units 70a, 70b, ... 70n. Computer 68 is fed instructions and data from a keyboard 72 and communicates diagnostic results via a monitor 74 or printer 76. As discussed hereinabove with reference to monitoring

and measuring device 20 of Fig. 1, each monitoring and measuring device 66a, 66b, ... 66n is

juxtaposable to a patient for collecting individualized medical data about the patient's

condition. Monitoring and measuring devices 66a, 66b, ... 66n may respectively take the form

of an electronic thermometer, an electronic blood pressure gauge, a pulmonary function

apparatus, a Doppler study apparatus, an EEG machine, an EKG machine, an EMG machine,

or a pressure measurement device, etc.

Digitizers 70a, 70b, ... 70n convert normally analog type signals into coded binary

pulses and transmit the resulting digital measurement signals to computer 68. Digitizers 70a,

70b, ... 70n may be incorporated into the housings or casing (not shown) enclosing all or part

of the respective monitoring and measuring devices 66a, 66b, ... 66n.

Keyboard 72 is used to feed computer 68 information for identifying the patient, for

example, the patient's age, sex, weight, and known medical history and conditions. Such medical conditions may include past diseases and genetic predispositions.

As further illustrated in Fig. 4, a plurality of diagnostic image generating apparatuses or scanners 78a, 78b, ... 78i are also connected to central computer 64 via respective hard-wired

or wireless telecommunications links 80a, 80b, ... 80i. Scanners 78a, 78b, ... 78i each generate

in electrically encoded form a visually readable image of an organic part of the patient.

Scanners 78a, 78b, ... 78i may each take the form of an MRI apparatus, a CAT scanner, an

X-ray machine, an ultrasonography apparatus (Figs. 8-15 and 20), or a video camera with or

without magnification optics for magnifying a sample on a slide.

Because of the enormous quantity of data necessary for storing images, central

computer 64 is connected to a bank of memories 82 at a central storage and information processing facility 84. Diagnosis of patient conditions may be undertaken by central computer

64 alone or in cooperation with local computers 24 or 68.

As illustrated in Fig. 5, local computers 24 and 68 transmit information to central

computer 64 in data packets or modules each include a first string of binary bits 86

representing the transmitting station 60a, 60b, a second bit string 88 identifying the patient, a

bit group 90 designating the parameter which is being transmitted, another bit group 92 coding

the particular measured value of the parameter, a set of bits 94 identifying the point on the

patient at which the measurement was taken, and another bit set 96 carrying the time and date

of the measurement. Other bit codes may be added as needed.

As shown in Fig. 6, a computerized slide scanning system comprises a slide carrier 100

mountable to a microscope stage and a slide positioning device 102 mechanically linked to the

slide carrier 100 for shifting the carrier along a path determined by a computer 104. Computer

104 may be connected to an optional transport or feed assembly 106 which delivers a series of slides (not shown) successively to slide carrier 100 and removes the slides after scanning.

Computer 104 is also connected to an optical system 108 for modifying the

magnification power thereof between successive slide scanning phases. Light emerging from

optical system 108 is focused thereby onto a charge coupled device ("CCD") 110 connected to computer 104 for feeding digitized video images thereto.

Computer 104 performs a line and texture analysis on the digitized image information

from CCD 110 to determine the presence of different organic structures and microorganisms.

The different textured regions are parameterized as to size, shape and location and the derived

parameters are compared to values in a memory to identify microscopic structures. The

texture and line scanning is repeated at different magnification levels.

Computer 104 may be connected to a keyboard 112, a printer 114, and a modem 16.

Modem 116 forms part of a telecommunications link for connecting computer 104 to a remote

data processing unit such as computer 64 in Fig. 4.

Image generating apparatus 42 in Fig. 1 may take the form of the computerized slide scanning system of Fig. 6.

As shown in Fig. 7, a device for measuring a diagnostic parameter and transmitting the

measurement over the telephone lines comprises a monitoring and measuring device 118 which

may take the form, for example, of an electronic thermometer, an electronic blood pressure

gauge, a pulmonary function apparatus, a Doppler study apparatus, an EEG machine, an EKG

machine, an EMG machine, or a pressure measurement device, etc., or include a plurality of

such components. Monitoring and measuring device 118 is connected at an output to a

digitizer 120 which in turn is coupled to a modulator 122. Modulator 122 modulates a carrier

frequency from a frequency generator 124 with the data arriving from monitoring and measuring device 118 via digitizer 120 and transmits the modulated signal to an electroacoustic

transducer 126 via an amplifier 128. Transducer 126 is removably attachable via a mounting

element 130 to the mouthpiece of a telephone handset (not shown) and generates a pressure

wave signal which is converted by a microphone in the handset mouthpiece back to an electrical signal for transmission over the telephone lines. Of course, transducer 126 may be omitted and modulator 122 connected directly to a telephone line.

The system of Fig. 7 enables the transmission of specialized medical data directly over

the telephone lines to a central computer (e.g. computer 64 in Fig. 4) which utilizes the

incoming data to perform a diagnostic evaluation on the patient.

Monitoring and measuring device 118 may include traditional medical instrumentation such as a stethoscope or modern devices such as a CCD.

Fig. 8 shows an ultrasonographic image generating apparatus which may be used in the

medical diagnostic system of Fig. 1 (see reference designation 42) or in the medical diagnostic

system of Fig. 4 (see reference designations 78a, 78b, ... 78i). A flexible web 132 carries a

plurality of piezoelectric electroacoustic transducers 134 in a substantially rectangular array. Transducers 134 are each connectable to an ultrasonic signal generator 136 via a switching circuit 138. Switching circuit 138 is operated by a control unit 140 to connect tranducers 134

to signal generator 136 in a predetermined sequence, depending on the area of a patient's body

which is being ultrasonically scanned.

Web 132 also carries a multiplicity of acoustoelectric transducers or sensors 142 also

arranged in a substantially rectangular array. Sensors 142 are connected to a switching circuit

144 also operated by control unit 140. An output of switching circuit 144 is connected to a

sound or pressure wave analyzer 146 via an amplifier 148. Web 132 is draped over or placed around a portion of a patient's body which is to be

monitored ultrasonically. Control unit 140 then energizes signal generator 136 and operates

switching circuit 138 to activate transducers 134 in a predetermined sequence. Depending on

the transducer or combination of transducers 134 which are activated, control unit 140

operates switching circuit 144 to connect a predetermined sequence of sensors 142 to pressure

wave analyzer 146. Pressure wave analyzer 146 and control unit 140 cofunction to determine

three dimensional structural shapes from the echoes detected by sensors 142.

Control unit 140 is connected to ultrasonic signal generator 136 for varying the

frequency of the generated signal. Fig. 9 shows a modified ultrasonography web 150 having a limited number of

electroacoustic transducers 152 and generally the same number and disposition of sensors 154

as in web 132.

Web 132 or 150 may be substantially smaller than illustrated and may corresponding

carry reduced numbers of transducers 134 and 152 and sensors 142 and 154. Specifically, web

132 or 150, instead of being a sheet large enough to wrap around a torso or arm of a patient,

may take a strip-like form which is periodically moved during use to different, predetermined

locations on the patient. Control unit 140 and pressure wave analyzer 146 are programmed to

detect internal organic structures from the data obtained at the different locations that the web

132 or 150 is juxtaposed to the patient.

Fig. 10 illustrates a modification of the ultrasonography apparatus of Figs. 8 and 9

which is employable in diagnostic or therapeutic operations involving the insertion of an

instrument into a patient. A control unit 156 for performing operations of control unit 140 is

connected at an output to a video monitor 158. As discussed hereinafter with reference to Figs. 12 and 13, a diagnostician, surgeon or other medical specialist inserts a distal end of a medical instrument into a patient in response to video feedback provided by the ultrasonography apparatus including video monitor 158.

As further illustrated in Fig. 10, an a-c current or ultrasonic signal generator 160 is

connected via a switching circuit 162 to different piezoelectric type electroacoustic transducers

164 in seriatum. Transducers 162 are mounted in interspaced fashion to a flexible web 166

which also carries an array of spaced piezoelectric type acoustoelectric transducers 168.

Web is placed adjacent to a skin surface of a patient. In some cases, it may be

beneficial to provide a layer of fluid between the skin surface of the patient and the web 166 to

facilitate ultrasonic wave transmission from web 166 to the patient and from the patient back

to the web. In response to the periodic energization of transducers 162, ultrasonic pressure

waves are reflected from internal organic structures of the patient and sensed by

acoustoelectric transducers 168. Electrical signals generated by transducers 168 in response to

the reflected pressure waves are fed via a switching circuit 170 to control unit 156.

As discussed hereinabove with reference to control unit 140 in Fig. 8, control unit 156

controls switching circuits 162 and 170 to energize emitting transducers 164 in a

predetermined sequence and and to selectively couple receiving transducers 168 in a pre-

established sequence to a pressure wave or ultrasonic frequency analyzer 172 in control unit

156. The sequencing depends on the portion of the patient being monitored.

In addition to pressure wave or ultrasonic frequency analyzer 172, control unit 156

includes a view selector 174 and a filter stage 176. View selector 174 is operatively connected

at an input to analyzer 172 and at an output to video monitor 158 for selecting an image for

display from among a multiplicity of possible images of the internal organs detected by analyzer 172. View selector 174 may be provided with an input 178 from a keyboard (not

shown) or other operator interface device for enabling an operator to select a desired view.

For example, during the insertion of a medical diagnostic or treatment instrument into the patient or during manipulation of that instrument to effect an operation on a targeted internal organ of the patient, the medical practitioner may sequentially select views from different

angles to optimize the practitioner's perception of the spatial relation between the distal tip of

the instrument and the patient's internal organs.

Filter stage 176 is operatively connected to analyzer 172 and video monitor 158 for

optionally eliminating a selected organ from the displayed image. Filter stage 176 is provided

with an input 180 from a keyboard (not shown) or other operator interface device for enabling

an operator to select an organ for deletion from the displayed image. In one example of the

use of filter stage 176, blood moving through a vessel of the vascular system is deleted to enable viewing of the blood vessel walls on monitor 158. This deletion is easily effected

starting from conventional techniques such as the Doppler detection of moving bodies.

Filter stage 176 may also function to highlight selected organs. The pattern recognition

techniques discussed above are used to detect selected organs. The highlighting may be

implemented exemplarily through color, intensity, cross-hatching, or outlines.

As further illustrated in Fig. 10, control unit 156 is optionally connected at an output to

a frame grabber 182 for selecting a particular image for reproduction in a fixed hard copy via a

printer 184. In addition, as discussed hereinabove with respect to the telecommunications links

80a, 80b ... 80i in Fig. 4, ultrasonically derived real-time image information may be encoded by

a modulator 186 onto a carrier wave sent to a remote location via a wireless transmitter 188.

Fig. 11 depicts the ultrasonography apparatus of Fig. 10 in a form wherein control unit 156 (Fig. 10) is realized as a specially programmed general purpose digital computer 190. A

switching circuit or multiplexer 192 relays signals incoming from respective acoustoelectric

transducers 168 (Fig. 10) in a predetermined intercalated sequence to an analog-to-digital converter 194, the output of which is stored in a computer memory 196 by a sampling circuit

198 of computer 190. A wave analysis module 200 of computer 190 retrieves the digital data from memory 196 and processes the data to determine three dimensional organic structures inside a patient. This three-dimensional structural data is provided to a view selection module 202 for deriving two-dimensional images for display on monitor 158 (Fig. 10). A filter module 204 is provided for removing selected organs from the image presented on the visual display or

video montiro 158. Sampling circuit 198, wave analysis module 200, view selection module

202, and filter module 204 are program-modified generic digital circuits of computer 190.

Fig. 12 shows a use of a flexible ultrasonic sensor web 206 which may be any of the

flexible ultrasonic sensor webs described herein, except that web 206 is additionally provided

with a plurality of apertures or perforations 208. Upon the placement of web 206 in pressure-

wave transmitting contact with a skin surface of a patient P, elongate diagnostic or therapeutic instruments such as laparoscopic surgical instruments 210 and 212 are inserted through respective openings 208 to perform a surgical operation on a designated internal organ of the

patient PI . This operation is effectuated by viewing a real time image of the distal ends of the instruments 210 and 212 in relation to the patient's internal organic structures as determined

by control unit 156 or computer 190. Generally, the image on monitor 158 is viewed during

insertion of instruments 210 and 212 to enable a proper employment of those instruments.

Also, the video images on monitor 158 are viewed to enable a proper carrying out of the

"laparoscopic" surgical operation on the designated internal organ of the patient PI. Strictly speaking, this operation is not a laparoscopic operation, since a laparoscope is not used to

provide a continuing image of the patient's internal organic structures and the distal ends of

instruments 210 and 212.

There are multiple advantages to using sonographic web 206 instead of a laparoscope.

Fewer perforations need be made in the patient for the same number of surgical instruments.

In addition, multiple views of the patient's internal organic structures are possible, rather than

a single view through a laparoscope. Generally, these multiple views may differ from one

another by as little as a few degrees of arc. Also, particularly if web 206 is extended

essentially around patient PI, viewing angles may be from under the patient where a

laparoscopic could not realistically be inserted.

Web 206 may be used to insert tubular instruments such as catheters and drainage

tubes, for example, for thoracentesis and abscess drainage. The tubes or catheters are inserted

through apertures 208 under direct real time observation via monitor 158.

In addition to treatment, web 206 may be used to effectuate diagnostic investigations.

In particular, a biopsy instrument 214 may be inserted through an aperture 208 to perform a

breast biopsy, a liver biopsy, a kidney biopsy, or a pleural biopsy.

As illustrated in Fig. 13, a flexible ultrasonic sensor web 216, which may be any of the flexible ultrasonic sensor webs described herein, may be used in a diagnostic or therapeutic

operation utilizing a flexible endoscope-like instrument 218. Instrument 218 has a steering

control 220 for changing the orientation of a distal tip 222 of the instrument. Instrument 218

also has a port 224 connected to an irrigant source 226 and another port 228 connected to a

suction source. In addition, instrument 218 is provided a biopsy channel (not shown) through

which an elongate flexible biopsy instrument or surgical instrument 230 is inserted. Instrument 218 is considerably simplified over a conventional endoscope in that

instrument 218 does not require fiber-optic light guides for carrying light energy into a patient P2 and image information out of the patient. Instead, visualization of the internal tissues and organ structures of patient P2 is effectuated via monitor 158 and control unit 156 or computer

190. As discussed above with reference to Fig. 12, the sonographic imaging apparatus if web

216 is extended essentially around patient P2, images may be provided from multiple angles,

not merely from the distal tip 222 of instrument 218.

View selector 174 and organ filter stage 176 or view selection module 202 and filter

module 204 may function in further ways to facilitate viewing of internal organic structures. In

addition to organ removal and highlighting, discussed above, a zoom capability may be

provided. The zoom or magnification factor is limited only by the resolution of the imaging, which is determined in part by the frequency of the ultrasonic pressure waves.

Figs. 14 and 15 depict a specialized ultrasonic sensor web 232 in the form of a garment

such as a vest. Sensor vest 232 has arm holes 234 and 236, a neck opening 238 and fasteners

240 for closing the vest about a patient. In addition, sensor vest 232 is provided with a

plurality of elongate chambers 242 which receive fluid for expanding the vest into

conformation with a patient's skin surface, thereby ensuring contact of the vest with a patient's

skin surface and facilitating the transmission of ultrasonic pressure waves to and from

ultrasonic transducers 244. Fig. 14 shows a computer 246, a video monitor 248 and a printer

250 used as described above.

Sensor vest 232 may be understood as a container assembly having fluid-filled

chambers 242 with flexible inwardly facing walls (not separately designated) which conform to

the patient. As illustrated in Fig. 16, an ultrasonography apparatus comprises a container assembly

302 including a substantially rigid plate 304 attached to a flexible bladder or bag 306. Bladder or bag 306 is filled with a liquid and is sufficiently flexible to substantially conform to a patient when the container assembly 302 is placed onto a patient PT1, as illustrated in Fig. 17. A liquid may be deposited on the patient prior to the placement of container assembly 302 on patient PT1.

Plate 304 is provided with multiple ultrasonic pressure wave generators and detectors

308 as described above with respect to Figs. 8 and 9 and Figs. 14 and 15. Generators and

detectors 308 are connected to a computer 310 having essentially the same functional

structures and programming as computer 190 for implementing sequential generator

energization and sequential detector sampling, as described above. Computer 310 is connected

to a monitor 312 for displaying images of internal organs of patient PT1. Computer 310 has the capability of alternately displaying organ images from different angles, as discussed above.

Fig. 18 depicts another ultrasonography apparatus useful for both diagnostic investigations and minimally invasive surgical operations. The apparatus comprises a container

assembly 314 which includes a fluid-filled sack or bag 316 for receiving a patient PT2. Sack or

bag 316 include a flexible upper wall 318 which deforms to conform to the patient PT2 upon

placement of the patient onto the bag. Bag 316 is supported on tow or more sides by

substantially rigid walls or panels 320 and 322. Panels 320 and 322 are either integral with bag

316 or separable therefrom. Panels 320 and 322, as well as an interconnecting bottom panel

324, may be provided with multiple ultrasonic pressure wave generators and detectors (not

shown) as described above with respect to Figs. 8 and 9, Figs. 14 and 15, and Fig . 16. These

generators and detectors are connected to a computer 326 having essentially the same functional structures and programming as computer 190 for implementing sequential generator

energization and sequential detector sampling, as described above. Computer 326 is connected

to a monitor 328 for displaying images of internal organs of patient PT2. Computer 326 has

the capability of alternately displaying organ images from different angles, as discussed above.

The ultrasonic pressure wave generators and detectors may be provided in a separate carrier 330 disposable, for example, between bottom panel 324 and bag 316, as shown in Fig. 18.

As illustrated in Fig. 19, the ultrasonography apparatus of Fig. 19 may be used in

conjunction with a flexible web or cover sheet 332 identical to web 132, 150, or 206 (Fig. 8, 9,

or 12). Web or cover sheet 332 is operatively connected to computer 326 for providing

ultrasonically derived organ position and configuration data to the computer for displaying

organ images on monitor 328. The use of web or sheet 332 enables the disposition of

ultrasonic wave generators and detectors in a 360° arc about a patient PT3 (diagrammatically

illustrated in Fig,. 19), thereby facilitating image production. Where web or sheet 332 takes

the form of web 206, the sheet is provided with apertures (see Fig. 12 and associated description) for enabling the introduction of minimally invasive surgical instruments into the

patient PT3.

As discussed above, contact surfaces are advantageously wetted with liquid to facilitate

ultrasonic pressure wave transmission over interfaces.

As discussed hereinafter with reference to Fig. 20, video monitor 158 (Figs. 10, 12, and

13) or monitor 328 (Fig. 19) may take the form of a flexible video screen layer attached to web

132, 150, 166 or 206 (Fig. 8, 9, 10, 12) or web 332 (Fig. 19). This modification of the

ultrasonographic imaging devices discussed above is considered to be particulary advantageous in medical diagnosis and treatment procedures. The web or subtrate with the video screen is

disposed on a selected body portion of a patient, for example, the abdomen (Figs. 12 and 21)

or a shoulder (Figs. 22A, 22B) or knee (Fig. 23B), so that the substrate and the video screen

layer substantially conform to the selected body portion and so that the video screen is facing away from the body portion.

As shown in Fig. 20, an ultrasonographic device or system comprises a flexible

substrate or web 350 which carries a plurality of piezoelectric electroacoustic transducers 352

and a plurality of piezoelectric acoustoelectric transducers 354. A flexible video screen 356 is attached to substrate or web 350 substantially coextensively therewith. Video screen 356 may be implemented by a plurality of laser diodes (not shown) mounted in a planar array to a

flexible carrier layer (not separately designated). The diodes are protected by a cover sheet

(not separately illustrated) which is connected to the carrier layer. Energization componentry

is operatively connected to the diodes for energizing the diodes in accordance with an

incoming video signal to reproduce an image embodied in the video signal. In a video monitor,

the laser diodes are tuned to different frequency ranges, so as to reproduce the image in color.

The protective cover sheet may function also to disperse light emitted by the laser diodes, to

generate a more continuous image.

Substrate or web 350 and video screen 356 comprise an ultrasonic video coverlet or

blanket 358 which may be used with the control hardware depicted in Figs. 10 and 11. Reference numerals used in Figs. 10 and 11 are repeated in Fig. 20 to designate the same

functional components.

Electroacoustic transducers 352 are connected to a-c or ultrasonic signal generator 160

for receiving respective a-c signals of different frequencies. Generator 160 produces different frequencies which are directed to the respective electroacoustic transducers 352 by switching circuit 162. Pressure waveforms of different ultrasonic frequencies have different penetration

depths and resolutions and provide enhanced amounts of information to a digital signal processor or computer 360. As discussed above with reference to computer 190 of Fig. 11,

computer 360 is a specially programmed digital computer wherein functional modules are

realized as generic digital processor circuits operating pursuant to preprogrammed instructions.

As discussed above with reference to Fig. 11, switching circuit or multiplexer 192

relays signals incoming from respective acoustoelectric transducers 354 in a predetermined intercalated sequence to analog-to-digital converter 194, the output of which is stored in

computer memory 196 by sampling circuit 198. Wave analysis module 200 retrieves the digital data from memory 196 and processes the data to determine three dimensional organic structures inside a patient. This three-dimensional structural data is provided to view selection

module 202 for deriving two-dimensional images for display on video screen 256. Filter module 204 serves to remove selected organs, for example, overlying organs, from the image

presented on video screen 356. Sampling circuit 198, wave analysis module 200, view

selection module 202, and filter module 204 are program-modified generic digital circuits of

computer 360.

Computer 360 contains additional functional modules, for example, an organ

highlighter 362 and a superposition module 364. The functions of organ highlighter 362 are

discussed above with reference to organ filter 176 and 204 in Figs. 10 and 11. Organ

highlighter 362 operates to provide a different color or intensity or cross-hatching to different

parts of an image to highlight a selected image feature. For example, a gall bladder or an

appendix may be shown with greater contrast than surrounding organs, thereby facilitating perception of the highlighted organ on video screen 356. After organ filter 204 has removed

one or more selected organs from an electronic signal representing or encoding an image of internal organs, highlighter 362 operates to highlight one or more features of the encoded

image. Superposition module 364 effects the insertion of words or other symbols on the image displayed on video screen 356. Such words or symbols may, for example, be a diagnosis or

alert signal produced by a message generator module 366 of computer 360 in response to a

diagnosis automatically performed by a determination module 368 of computer 360. Module

368 receives the processed image information from waveform analysis module 200 and

consults an internal memory 370 in a comparison or pattern recognition procedure to

determine whether any organ or internal tissue structure of a patient has an abnormal

configuration. The detection of such an abnormal configuration may be communicated to the physician by selectively removing organs, by highlighting organs or tissues, or superimposing an alphanumeric message on the displayed image. Accordingly, message generator 366 may be

connected to organ filter 204 and organ highlighter 362, as well as to superposition module

364. The communication of an abnormal condition may be alternatively or additionally

effectuated by printing a message via a printer 372 or producing an audible message via a

speech synthesis circuit 374 and a speaker 376.

As discussed above, the ultrasonically derived three-dimensional structural information

from waveform analysis module 200 may be transmitted over a telecommunications link (not

shown in Fig. 20) via a modulator 378 and a transmitter 380. The transmitted information may

be processed at a remote location, either by a physician or a computer, to generate a diagnosis.

This diagnosis may be encoded in an electrical signal and transmitted from the remote location to a receiver 382. Receiver 382 is coupled with message generator module 366, which can

communicate the diagnosis or other message as discussed above.

Computer 360 is connected at an output to a video signal generator 384 (which may be incorporated into the computer). Video signal generator 384 inserts horizontal and vertical

synchs and transmits the video signal to video screen 356 for displaying an image of internal patient organs thereon.

Fig. 21 diagrammatically depicts a step in a "laparoscopic" cholecystectomy procedure

utilizing the ultrasonographic device or system of Fig. 20. Coverlet or blanket 358 is disposed on the abdomen of a patient P2 in pressure-wave transmitting contact with the skin. The skin

is advantageously wetted with liquid to facilitate ultrasonic pressure wave transmission.

Laparoscopic surgical instruments 210 and 212 (same as in Fig 12) are inserted through

respective openings 386 in coverlet or blanket 358 to perform a surgical operation a gall

bladder GB of the patient P2. This operation is effectuated by viewing a real time image of the

distal ends of the instruments 210 and 212 in relation to the patient's internal organic

structures as determined by computer 360. Generally, the image on video screen 356 is

viewed during insertion of instruments 210 and 212 to enable a proper employment of those

instruments.

As illustrated in Fig. 21, the gall bladder GB is highlighted (e.g., with greater contrast

in screen intensities) relative to other organs such as the liver LV, the stomach ST and the

large intestine LI. One or more of these organs may be deleted entirely by organ filter 204.

Computer 360 is instructed as to the desired display features via a keyboard (not illustrated in

Fig. 20) or a voice recognition circuit 388 operatively connected to various modules 202, 204

and 362. (It is to be noted that speech synthesis circuit 374 and voice recognition circuit 388 enable computer 360 to carry on a conversation with a user. Thus the user may direct the

computer to answer questions about the appearance of certain organs selected by the user.)

Generally, the images of the different organs GB, LV, ST and LI, etc., are displayed on

video screen 356 so as to substantially overlie the actual organs of the patient P2. To

effectuate this alignment of image and organ, markers 390, 392, 394 are placed on the patient

P2 at appropriate identifiable locations such as the xyphoid, the umbilicus, the pubis, etc. The

markers are of a shape and material which are easily detected by ultrasonic wave analysis and

provide computer 360 with a reference frame for enabling the alignment of organ images on screen 356 with the corresponding actual organs. During an operation, view selector 202 may be utilized (via keyboard command or voice recognition circuit 388) to adjust the relative

positions of image and organs to facilitate the performance of an invasive surgical operation.

As discussed above with reference, for example, to Fig. 13, the ultrasonographic device or

system of Fig. 20 may be used in other kinds of procedures.

As illustrated in Fig. 22A, an ultrasonographic coverlet or blanket 396 with attached

video screen (not separately designated) and connected computer 398 has a predefined shape

conforming to a shoulder SH. The coverlet or blanket 396 is flexible and thus deforms upon

motion of the shoulder (Fig. 22B). The coverlet or blanket 396 has a memory so that it returns

to the predefined shape when it is removed from the shoulder SH. The flexibility of the

coverlet or blanket 396 enables the display in real time of a filtered video image showing the

shoulder joint SJ during motion of the shoulder. This facilitates a diagnostic appraisal of the

joint.

Fig. 23 A illustrates an ultrasonic video cuff 400 with a computer 402. The cuff is

attachable in pressure-wave transmitting contact to a knee KN, as depicted in Fig. 23B. Cuff 400 conforms to the knee KN and follows the knee during motion thereof. A knee joint KJ is imaged on the cuff during motion of the knee KN, thereby enabling a physician to study the

joint structure and function during motion. Cuf 400 has a memory and returns to its predefined shape (Fig. 23 A) after removal from knee KN.

Video screen 356, as well as other video monitors disclosed herein, may be a lenticular

lens video display for presenting a stereographic image to a viewer. The ultrasonic processor,

e.g., computer 190 or 360, operates to display a three-dimensional image of the internal organs

on the lenticular lens video display. 118. Because of the stereoscopic visual input a surgeon is

provided via video display 356, he or she is better able to manipulate instruments and 212

during a surgical procedure.

Electroacoustic transducers 134, 164, 352 in an ultrasonographic coverlet or blanket 132, 166, 206, 216, 358 as described herein may be used in a therapeutic mode to dissolve clot

in the vascular system. The coverlet or blanket is wrapped around the relevant body part of a

patient so that the electroacoustic transducers surround a target vein or artery. First, a scan is

effectuated to determine the location of the clot. Then, in a clot dissolution step, the

electroacoustic transducers are energized to produce ultrasonic pressure waves of frequencies

selected to penetrate to the location of the clot. With a sufficiently large number of

transducers transmitting waves to the clot site simultaneously, the clot is disrupted and forced

away from the clot site. It is recommended that a filter basket be placed in the pertinent blood

vessels downstream of the clot site to prevent any large clot masses from being swept into the

brain or the lungs where an embolism would be dangerous.

The monitors disclosed herein, such as monitors 158, 248, 312, 328 and video screen

356, may be provided with a lenticular lens array (not shown) for generating a three- dimensional or stereoscopic display image when provided with a suitable dual video signal.

Such a dual signal may be generated by the waveform analysis computer 190, 310, 326, 360

with appropriate programming for the view selection module 202 to select two vantage points spaced by an appropriate distance. Lenticular lens video displays, as well as the operation

thereof with input from two cameras, are disclosed in several U.S. patents, including U.S.

Patent No. 4,214,257 to Yamauchi and U.S. Patent No. 4,164,748 to Nagata, the disclosures

of which are hereby incorporated by reference.

It is to be noted that any of the ultrasonography devices or systems disclosed herein

may be used in a robotic surgical procedure wherein one or more surgeons are at a remote

location relative to the patient. The performance of robotic surgery under the control of the

distant experts is disclosed in U.S. Patents Nos. 5,217,003 and 5,217,453 to Wilk, the

disclosures of which are hereby incorporated by reference. Video signals transmitted to the

remote location may be generated by the analysis of ultrasonic waves as disclosed herein.

The ultrasonography devices or systems disclosed herein may be used in conjunction

with other kinds of scanning devices, for example, spectral diagnosis and treatment devices

described in U.S. Patents Nos. 5,305,748 to Wilk and 5,482,041 to Wilk et al. (those

disclosures incorporated by reference herein). It may be possible to incorporate the

electromagnetic wave generators and sensors of those spectral diagnosis and treatment devices

into the coverlet or blanket of the present invention.

As illustrated in Fig. 24, a medical imaging device comprises a planar firm substrate

404, a substantially flat video screen 406 provided on the substrate, and a flexible bag 408

connected to the substrate. Flexible bag 408 contains a fluidic medium such as water or gel

capable of transmitting pressure waves of ultrasonic frequencies and is disposed on a side of the substrate opposite the video screen. As discussed above, a scanner 410 including an ultrasonic waveform generator 412 and a computer-implemented ultrasonic signal processor

414 is operatively connected to video screen 406 for providing a video signal thereto. The video signal encodes an image of internal tissues of a patient PT4 upon placement of medium-

containing bag 408, substrate 404, and video screen 406 against the patient. The images of

internal tissues and organs off the patient, including the stomach SH, the heart HT, the lungs LG, the small intestine SE, and the large intestine LE, are displayed on screen 406 at positions

generally overlying the respective actual tissues and organs of the patient PT4.

Video screen 406 and substrate 404 may be provided with aligned apertures 415 for

enabling the traversal of the video screen and the substrate by medical instruments as discussed above with reference to Fig. 21.

Figs. 25 and 26 show another medical imaging device comprising a flexible bag 416

containing a fluidic medium such as water or gel. A multiplicity of substantially rigid planar

substrates or carrier pads 418 together with respective flat video screens 420 attached thereto

are mounted to an upper surface of bag 416. Bag 416 serves in part to movably mount pads 418 with their respective video screens 420 to one another so that the orientations or relative

angles of the video screen can be adjusted to conform to a curving surface of a patient PT5, as

shown in Fig. 26. Again, a scanner 422 including an ultrasonic waveform generator 424 and a

computer-implemented ultrasonic signal processor 426 is operatively connected to video

screens 420 for providing respective video signals thereto. The video signals encode

respective images of internal tissues of a patient PT5 upon placement of medium-containing

bag 416, substrates 418 and video screens 420 against the patient. As illustrated in Fig. 27 A,

the video images displayed on screen 420 may be substantially the same, with differences in the angle of view of a target organ ORG, depending on the locations and orientations of the

respective screens 420. Alternatively, in an enlarged view, a single image of the target organ

ORG may be displayed, with each screen 420 displaying only a part of the total image. The

technology for implementing these displays over video screens 420 is conventional and well

known.

Scanners 410 and 422 are ultrasonic scanners with the same components as other

ultrasonic scanners discussed herein, for example, with reference to Fig. 21. Briefly, scanners

410 and 422 each includes a plurality of electroacoustic transducers and a plurality of

acoustoelectric transducers disposed in respective arrays along the respective bag 408 or 416 so that ultrasonic pressure waves can travel through the fluidic medium in the respective bag from the electroacoustic transducers and to the acoustoelectric transducers. Computers or

processors 414 and 426 analyze incoming digitized ultrasonic sensor signals which are

produced in response to ultrasonic pressure waves reflected from various tissue interfaces in

the patient PT4 or PT5. From these incoming ultrasonic sensor signals, computers or

processors 414 and 426 determine three-dimensional shapes of tissue interfaces and organs

inside the patient PT4 or PT5.

As discussed above with reference to Fig. 21, it is recommended that markers be placed in prespecified locations on the patient to enable or facilitate an alignment of the displayed

tissue representations and the respective underlying actual tissues. The markers are easily

recognized by computer 426 and serve to define a reference frame whereby the positions and

the orientations of the multiple video screens 420 relative to the patient's internal tissues are

detectable. Thus, the position and the orientation of each video screen 420 relative to the

internal tissues and organs of the patient PT5 are determined to enable the display on the video screens 420 of images of selected target tissues of the patient. The reference markers facilitate the display on screens 420 of respective views of the same organ or tissues from

different angles depending on the positions and orientations of the various screens 420.

As discussed above, for example, with reference to Figs. 20 and 21, computers or

processor 414 and 426 may include a module 362, typically realized as a programmed general

computer circuit, for highlighting a selected feature of the internal organs of patient PT4 or

PT5. The highlighting is achievable by modifying the color or intensity of the selected feature

relative to the other features in the displayed image, thus providing a visual contrast of the

selected feature with respect to the other features of the displayed image. An intensity change may be effectuated by essentially blacking or whiting out the other portions of the image so

that the selected feature is the only object displayed on the video screen.

The imaging devices of Figs. 24 and 26 are optionally provided with a voice-

recognition circuit 388 and a speech synthesis circuit 374 (Fig. 20) operatively connected to

computer or processor 414 and 426. Advantages and uses of these components are discussed

above with reference to Fig. 20. As further described above, computers or processors 414 and

426 are possibly programmed for automated diagnosis based on pattern recognition, with the

computed diagnosis being communicated to the user physicians via speech synthesis circuit 374.

As illustrated in Fig. 28, the imaging device of Figs. 26 and 27 is advantageously

provided with a plurality of apertures or passageways 428 extending through bag 416 in the

interstitial spaces between video screens 420. Passageways 428 receive respective tubular

cannulas 430 which extend both through the passageways and respective openings (not shown)

in the skin and abdominal wall of the patient PT5. Medical instruments such as a laparoscopic forceps 432 are inserted through passageways 428 for performing an operation on internal

target tissues of patient PT5 essentially under direct observation as afforded by video screens 420. The distal ends of the medical instruments 432, inserted into patient PT5 in the field of view of the imaging system, are displayed on one or more video screens 420 together with

internal target tissues of the patient. The uses of the imaging device of Figs. 25 and 26 with

passageways 428 as illustrated in Fig. 28 are substantially identical to the uses and modes of

operation described above with reference to Figs. 20 and 21.

It is to be noted that bag 416 may be replaced by a plurality of bags (not illustrated) all

filled with a fluidic medium through which ultrasonic pressure waves may be transmitted. Each

planar substrate or carrier pad 418 and its respective video screen may be attached to a

respective fluid-filled bag. In this modification of the ultrasonographic device of Figs. 25 and

26, apertures performing the function of passageways 428 (Fig. 28) are naturally formed as

gaps or spaces between adjacent bags. Separate coupling elements (not illustrated) must be provided between adjacent video screens 420 for forming an integral structure while enabling

at least limited flexing between adjacent video screens 420.

It is to be additionally understood that substrates 418 may be formed as carrier layers

for active picture elements of video screens 420 and may be visually indistinguishable from the

video screens 420.

The imaging devices of Figs. 24 and 25, 26 may include a transmitter 380 and a

receiver 382 (Fig. 20) for operatively connecting scanners 410 and 422 and particularly

computers or processors 414 and 426 to a long-distance hard- wired or wireless

telecommunications link. As pointed out above, image data transmitted over the

telecommunications link to a video monitor at a remote location will enable observation of the patient's internal tissues by distant specialists who may also operate on the patients robotically via the telecommunications link.

Where the imaging device of Figs. 25-28 is used to diagnose or treat a limb or a joint,

planar substrates 418 and video screens 420 have sizes and two-dimensional shapes which facilitate substantial conformity with the limb or joint. To facilitate the use of the imaging

device in invasive surgical procedures, the images provided on video screens 420 may be stereoscopic or holographic. Thus, manipulation of medical instrument 432 so that its distal

end engages desired internal tissues is facilitated. The imaging device thus may include

elements for providing a stereoscopic or holographic image to a viewer, the scanner including

means for energizing the elements to produce the stereoscopic or holographic image.

Although the invention has been described in terms of particular embodiments and

applications, one of ordinary skill in the art, in light of this teaching, can generate additional

embodiments and modifications without departing from the spirit of or exceeding the scope of

the claimed invention. It is to be noted, for example, that multiple images may be provided on

a single video screen, pursuant to conventional windows-type overlay techniques. Thus, one

window or video image may show an organ from one point of view or angle, while another window on the same screen may show the same organ from a different vantage point.

Alternatively, one window may show a first organ, while another window displays one or more

organs underlying the first organ. In this case, the underlying organs may be shown in

phantom line in the first window, while the overlying organs is shown in phantom lines in the

second window. Of course, all such operating modes apply to multiple video screens as well

as to a single screen. Thus, one screen may display an overlying organ from one angle, while

an adjacent organ displays an underlying organ from a different angle. A display window on a video screen of the present invention may be used alternatively for the display of textual

information pertaining to the tissues and organs displayed in other video windows. Such

information may include diagnostic information determined by the analyzing computer.

Accordingly, it is to be understood that the drawings and descriptions herein are

proferred by way of example to facilitate comprehension of the invention and should not be

construed to limit the scope thereof.

Claims

WHAT IS CLAIMED IS:

1. A medical system, comprising:

a carrier disposable in pressure-wave-transmitting contact with a patient, said carrier

being provided with at least one aperture enabling traversal of said carrier by a medical

instrument so that a distal end of said medical instrument lies inside the patient while said

carrier is disposed adjacent to a skin surface of the patient;

at least one electroacoustic transducer attached to said carrier;

an a-c current generator operatively connected to said transducer for energizing said

transducer with an electrical signal of a pre-established ultrasonic frequency to produce a first

pressure wave; at least one acoustoelectric transducer attached to said carrier; and analyzing means operatively connected to said acoustoelectric transducer for

determining three-dimensional shapes of internal organs of the patient by analyzing signals generated by said acoustoelectric transducer in response to second pressure waves produced at

internal organs of the patient in response to said first pressure wave.

2. The system defined in claim 1, further comprising a video monitor linked to said

analyzing means for displaying an image of said internal organs.

3. The system defined in claim 2, further comprising a view selector operatively

connected to said analyzing means and said video monitor for selecting said image from among

a multiplicity of possible images of said internal organs.

4. The system defined in claim 2, further comprising a filter stage operatively connected to said analyzing means and said video monitor for eliminating a selected organ from said

image.

5. The system defined in claim 1 wherein said carrier carries a plurality of

electroacoustic transducers attached to said carrier in a predetermined array, further

comprising means for energizing said electroacoustic transducers in a predetermined sequence.

6. The system defined in claim 1 wherein said carrier carries a plurality of

acoustoelectric transducers attached to said carrier in a predetermined array, further

comprising means for receiving signals from said acoustoelectric transducers in a

predetermined sequence.

7. The system defined in claim 1 wherein said carrier is provided with at least one

chamber for holding a fluid, said electroacoustic transducer and said acoustoelectric transducer

being in pressure-wave communication with said chamber, thereby facilitating pressure wave

transmission from said electroacoustic transducer to the patient and from the patient to said

acoustoelectric transducer.

8. The system defined in claim 1 wherein said carrier is a flexible web taking the form

of a garment.

9. A method for performing a medical operation, comprising: providing a medical instrument and a carrier disposable in pressure-wave-transmitting

contact with a patient, said carrier also having at least one electroacoustic transducer and at least one acoustoelectric transducer attached to said carrier;

disposing said carrier adjacent to a skin surface of the patient so that said carrier is in acoustic or pressure-wave-transmitting contact with said skin surface; after disposition of said carrier adjacent to said skin surface, energizing said

electroacoustic transducer with an electrical signal of a pre-established ultrasonic frequency to

produce a first pressure wave;

inserting a distal end of said medical instrument into the patient so that said distal end

of said medical instrument is disposed inside the patient while said carrier is disposed adjacent

to said skin surface; and

automatically analyzing signals generated by said acoustoelectric transducer in response

to second pressure waves produced at internal organs of the patient and at said distal end of

said medical instrument in response to said first pressure wave to thereby determine three-

dimensional shapes of the internal organs of the patient and a location of said distal end of said

medical instrument relative to said internal organs, thereby enabling a real time manipulation of

said instrument to effectuate a medical operation on a selected one of said internal organs.

10. The method defined in claim 9 wherein said carrier has at least one aperture, the

inserting of said medical instrument including passing said distal end of said medical instrument

through said aperture.

11. The method defined in claim 10 wherein said medical instrument is taken from the group consisting essentially of biopsy instruments, drains, tubes, catheters, and laparoscopic

instruments.

12. The method defined in claim 9, further comprising generating a printed image of

said internal organs in response to the analysis of signals generated by said acoustoelectric transducer.

13. The method defined in claim 9, further comprising generating an additional signal encoding the determined three dimensional shapes of the internal organs and wirelessly transmitting said additional signal to a remote location.

14. A medical system, comprising:

a fluid-filled container, said container having a flexible wall conformable to a patient;

at least one electroacoustic transducer in operative contact with said container for

generating pressure waves in fluid disposed in said container;

transducer with an electrical signal of a pre-established ultrasonic frequency to produce a first pressure wave in said fluid in said container; at least one acoustoelectric transducer in operative contact with said container for

receiving and sensing pressure waves traveling in said fluid in said container; and

analyzing means operatively connected to said acoustoelectric transducer for

determining three-dimensional shapes of internal organs of the patient by analyzing signals

generated by said acoustoelectric transducer in response to second pressure waves produced at internal organs of the patient in response to said first pressure wave and transmitted through said fluid in said container to said acoustoelectric transducer.

15. The system defined in claim 14 wherein said container is part of an assembly

including a plurality of substantially rigid panels partially surrounding said container, thereby

supporting said container and the patient disposed on said container.

16. The system defined in claim 15 wherein said panels define a U-shaped holder, said

container being disposed in said holder.

17. The system defined in claim 15 wherein at least one of said electroacoustic transducer and said acoustoelectric transducer is mounted to one of said panels.

18. The system defined in claim 14 wherein said container is part of an assembly

including a substantially rigid panel, at least one of said electroacoustic transducer and said

acoustoelectric transducer being mounted to said substantially rigid panel.

19. The system defined in claim 14, further comprising a video monitor linked to said

analyzing means for displaying an image of said internal organs.

20. The system defined in claim 19, further comprising a view selector operatively

a multiplicity of possible images of said internal organs.

21. The system defined in claim 19, further comprising a filter stage operatively connected to said analyzing means and said video monitor for eliminating a selected organ

from said image.

22. The system defined in claim 14 wherein said container is in operative contact with a

plurality of electroacoustic transducers disposed in a predetermined array, further comprising

means for energizing said electroacoustic transducers in a predetermined sequence.

23. The system defined in claim 14 wherein said container is in operative contact with a

plurality of acoustoelectric transducers disposed in a predetermined array, further comprising

means for receiving signals from said acoustoelectric transducers in a predetermined sequence.

24. A system for use in a medical operation, comprising: a container assembly defining a fluid-filled chamber, said container assembly including a

flexible wall partially defining said chamber, said flexible wall being conformable to and

disposable in a pressure-wave-transmitting relationship with a patient, said container assembly

including a panel provided with a plurality of apertures enabling traversal of said panel by a

medical instrument so that a distal end of said medical instrument lies inside the patient while

the patient is disposed in pressure-wave-transmitting contact with said fluid-filled chamber;

at least one electroacoustic transducer operatively mounted to said container assembly

for generating pressure waves in the patient and in fluid disposed in said chamber;

an a-c current source operatively connected to said transducer for energizing said

transducer with an electrical signal of a pre-established ultrasonic frequency to produce first pressure waves in the patient and in said fluid in said chamber;

at least one acoustoelectric transducer mounted to said container assembly for

receiving and sensing pressure waves reflected from internal organs of the patient; and

analyzing means operatively connected to said acoustoelectric transducer for determining three-dimensional shapes of the internal organs of the patient and a location of

said distal end of said medical instrument by analyzing signals generated by said acoustoelectric

transducer in response to the pressure waves reflected from the internal organs of the patient

and pressure waves produced at said distal end of said medical instrument in response to said

first pressure waves.

25. The system defined in claim 24, further comprising a video monitor linked to said

analyzing means for displaying an image of said internal organs.

26. The system defined in claim 25, further comprising a view selector operatively

a multiplicity of possible images of said internal organs.

27. The system defined in claim 25, further comprising a filter operatively connected to

said analyzing means and said video monitor for eliminating a selected organ from said image.

28. The system defined in claim 24 wherein said container assembly includes a plurality

of electroacoustic transducers disposed in a predetermined array, further comprising means for

energizing said electroacoustic transducers in a predetermined sequence.

29. The system defined in claim 24 wherein said container assembly includes a plurality of acoustoelectric transducers disposed in a predetermined array, further comprising means for

receiving signals from said acoustoelectric transducers in a predetermined sequence.

30. A method for performing a medical operation, comprising:

providing (1) a medical instrument and (2) a container assembly defining a fluid-filled chamber, said container assembly including a flexible wall partially defining said chamber, said

flexible wall being conformable to and disposable in pressure-wave-transmitting relationship with a patient, said container assembly having at least one electroacoustic transducer in

operative contact with said chamber for generating pressure waves in the patient and in fluid in

said chamber, said container assembly also having at least one acoustoelectric transducer in

operative contact with said chamber for detecting pressure waves in the patient and in said

fluid in said chamber;

disposing said container assembly and the patient proximately to one another so that

said flexible wall substantially conforms to a skin surface of the patient to enable an acoustic or

pressure-wave-transmitting relationship between said skin surface and said fluid in said

chamber;

after disposition of said container assembly and the patient adjacent to one another, energizing said electroacoustic transducer with an electrical signal of a pre-established

ultrasonic frequency to produce first pressure waves in said fluid in said chamber and in the

patient;

of said medical instrument is disposed inside the patient while said flexible wall is disposed proximately to and substantially conforms to said skin surface; and

automatically analyzing signals generated by said acoustoelectric transducer in response to second pressure waves produced at internal organs of the patient and at said distal end of

said medical instrument in response to said first pressure waves to thereby determine three-

said instrument to effectuate a medical operation on a selected one of said internal organs and

transmitted through said fluid in said chamber to said acoustoelectric transducer.

31. The method defined in claim 30 wherein said container assembly has a cover

member disposed over the patient and provided with a plurality of apertures, the inserting of

said medical instrument including passing said distal end of said medical instrument through one of said apertures.

32. The method defined in claim 31 wherein said medical instrument is taken from the

group consisting essentially of biopsy instruments, drains, tubes, catheters, and laparoscopic

instruments.

33. The method defined in claim 30 wherein said container assembly is provided with a

energizing said electroacoustic transducers in a predetermined sequence.

34. The method defined in claim 30 wherein said container assembly is provided with a plurality of acoustoelectric transducers disposed in a predetermined array, further comprising receiving signals from said acoustoelectric transducers in a predetermined sequence.

35. The method defined in claim 30, further comprising generating a video image of

said internal organs and said distal end of said medical instrument in response to the analysis of

signals generated by said acoustoelectric transducer.

36. An imaging device comprising:

a flexible substrate;

a flexible video screen disposed on said substrate; and

a scanner operatively connected to said video screen for providing a video signal

thereto, said video signal encoding an image of objects located near said substrate.

37. The imaging device defined in claim 36 wherein said scanner is provided with an

analyzing component for analyzing scanner sensor signals and determining therefrom three-

dimensional shapes of said objects.

38. The imaging device defined in claim 37 wherein said analyzing component includes

means for highlighting a selected feature of said objects.

39. The imaging device defined in claim 38 wherein said means for highlighting

includes means for varying video image intensity.

40. The imaging device defined in claim 37, further comprising voice-recognition

circuitry operatively connected to said analyzing component.

41. The imaging device defined in claim 37, further comprising speech synthesis circuitry operatively connected to said analyzing component.

42. The imaging device defined in claim 37 wherein said analyzing component includes means for performing automated diagnoses based in part on image information derived from

said scanner sensor signals.

43. The imaging device defined in claim 37 wherein said substrate and said video screen

are provided with a plurality of mutually aligned apertures enabling traversal of said substrate

and said video screen by medical instruments.

44. The imaging device defined in claim 37, further comprising a transceiver interface for operatively connecting said scanner, including said analyzing component, to a long-distance

telecommunications link.

45. The imaging device defined in claim 37 wherein said scanner includes a view

selector operatively connected to said analyzing means and said video screen for selecting said

image from among a multiplicity of possible images of said objects.

46. The imaging device defined in claim 37, further comprising a filter stage operatively connected to said analyzing means and said video screen for eliminating a selected object from said image.

47. The imaging device defined in claim 36 wherein said scanner includes at least one

electroacoustic transducer, an a-c current generator operatively connected to said transducer

for energizing said transducer with an electrical signal of a pre-established ultrasonic frequency

to produce a first pressure wave, at least one acoustoelectric transducer, and an analyzing component operatively connected to said acoustoelectric transducer for determining three- dimensional shapes of said objects by analyzing signals generated by said acoustoelectric

transducer in response to second pressure waves produced at said objects in response to said

first pressure wave.

48. The imaging device defined in claim 47 wherein at least one of the transducers are

mounted to said substrate.

49. The imaging device defined in claim 47 wherein said electroacoustic transducer is one of a plurality of electroacoustic transducers each capable of generating a pressure wave in

a respective frequency range different from the frequency ranges of the other of said

electroacoustic transducers, said a-c current generator being operatively connected to said

electroacoustic transducers for energizing said electroacoustic transducers with electrical

signals of different pre-established ultrasonic frequencies to produce respective first pressure

waves in the respective frequency ranges, said acoustoelectric transducer being one of a

plurality of acoustoelectric transducers capable of sensing pressure waves in a plurality of different frequency ranges.

50. The imaging device defined in claim 36 wherein said substrate and said video screen

have shapes conforming in part to a human limb.

51. The imaging device defined in claim 36 wherein said substrate and said video screen

comprise a dual layered blanket member provided with a plurality of apertures each enabling traversal of said blanket member by a medical instrument.

52. The imaging device defined in claim 36 wherein said video screen includes elements for providing a stereoscopic image to a viewer, said scanner including means for energizing

said elements to produce said stereoscopic image.

53. The imaging device defined in claim 36 wherein said substrate carries a plurality of

electroacoustic transducers attached to said substrate in a predetermined array, said scanner

including means for energizing said electroacoustic transducers in a predetermined sequence.

54. The imaging device defined in claim 36 wherein said substrate carries a plurality of

acoustoelectric transducers attached to said substrate in a predetermined array, said scanner

including means for receiving signals from said acoustoelectric transducers in a predetermined

sequence.

55. A medical method comprising: providing an imaging device including a flexible substrate, a flexible video screen

disposed on said substrate, and a scanner operatively connected to said video screen; disposing said substrate with said video screen on a body portion of a patient so that

said substrate and said video screen substantially conform to the body portion of the patient and so that said video screen is facing away from the body portion of the patient; and

after the disposition of said substrate and said video screen on the body portion of the

patient, operating said scanner to provide a video signal to said video screen, said video signal

encoding an image of internal tissues of the patient.

56. The method defined in claim 55, further comprising operating said video screen to

reproduce said image so that internal tissue representations as displayed on said video screen substantially overlie respective corresponding actual tissues of the patient.

57. The method defined in claim 56, further comprising placing markers on the patient

for facilitating the reproducing of said image so that the internal tissue representations on said

video screen substantially overlie respective corresponding actual tissues of the patient.

58. The method defined in claim 55 wherein the operating of said scanner to provide

said video image includes automatically analyzing scanner sensor signals and determining

therefrom three-dimensional shapes of the internal tissues of the patient.

59. The method defined in claim 55 wherein said substrate and said video screen are

provided with a plurality of mutually aligned apertures, further comprising: providing a medical instrument;

inserting a distal end portion of said instrument into the patient through one of said

apertures;

after insertion of said distal end portion, manipulating said instrument from outside the patient to perform an operation on at least one of the internal tissues of the patient, said image being viewed on said video screen while said instrument is being manipulated.

60. A medical treatment method comprising:

using an ultrasonic scanner to locate undesirable material lodged in internal tissues of a

patient;

wrapping a flexible web about a portion of the patient including said internal tissues,

said flexible web being placed in pressure-wave transmitted contact with said portion of the

patient;

electrically energizing a plurality of electroacoustic transducers mounted to said web to produce ultrasonic pressure waves penetrating through the patient to said internal tissues; and

disrupting said undesirable material by a convergence of said ultrasonic pressure waves

at said internal tissues .

61. The method defined in claim 60 wherein said electroacoustic transducers are

energized by electrical signals having respective frequencies selected to penetrate to said

internal tissues from the respective electroacoustic transducers.

62. A medical imaging method, comprising: providing a thin video screen;

disposing video screen adjacent to a patient so that said video screen overlies selected

internal tissues of the patient;

operating an ultrasonic scanner operatively connected to said video screen to provide a video signal thereto, said video signal encoding an image of the selected internal tissues of the

patient; and

operating said video screen in response to said video signal to reproduce said image so that internal tissue representations as displayed on said video screen substantially overlie

respective corresponding ones of the selected internal tissues of the patient..

63. The imaging method defined in claim 62 wherein said video screen is connected to

a substrate containing ultrasonic transducers of said ultrasonic scanner, also comprising

disposing said substrate in operative contact with the patient to enable transmission of

ultrasonic pressure waves between the transducers and the selected internal tissues of the

patient.

64. The method defined in claim 62 wherein the operating of said ultrasonic scanner to

provide said video image includes automatically analyzing scanner sensor signals and

determining therefrom three-dimensional shapes of the selected internal tissues of the patient.

65. An imaging device comprising:

a video screen;

positioning elements connected to said video screen for enabling placement of said video screen in juxtaposition to a patient so that an image of internal tissues of the patient

appears on said video screen at a location substantially overlying said internal tissues; and an ultrasonic scanner operatively connected to said video screen for providing a video

signal thereto, said video signal encoding an image of said internal tissues.

66. The imaging device defined in claim 65 wherein said positioning elements include a

flexible substrate, said video screen being flexible and mounted to said substrate.

67. The imaging device defined in claim 65 wherein said scanner is provided with an

analyzing component for analyzing scanner sensor signals and determining therefrom three- dimensional shapes of said objects.

68. An imaging device comprising:

a plurality of substantially planar substrates;

at least one flexible connection coupling said substrates to one another so that said

substrates are extendable at a variable angle with respect to one another;

a plurality of video screens, each of said substrates carrying at least one of said video

screens; and a scanner operatively connected to said video screens for providing respective video

signals thereto, said video signals each encoding an image of objects located near a respective

one of said substrates.

69. The imaging device defined in claim 68 wherein said scanner is provided with an analyzing component for analyzing scanner sensor signals and determining therefrom three- dimensional shapes of said objects.

70. The imaging device defined in claim 69 wherein a plurality of apertures are provided in interstitial spaces between said substrates for enabling traversal of the imaging

device by medical instruments.

71. The imaging device defined in claim 69, further comprising a transceiver interface

for operatively connecting said scanner, including said analyzing component, to a long-distance

telecommunications link.

72. The imaging device defined in claim 69 wherein said scanner includes a view selector operatively connected to said analyzing means and said video screen for selecting said

image from among a multiplicity of possible images of said objects.

73. The imaging device defined in claim 69, further comprising a filter stage operatively

connected to said analyzing means and said video screen for eliminating a selected object from

said image.

74. The imaging device defined in claim 68 wherein said scanner includes at least one

to produce a first pressure wave, at least one acoustoelectric transducer, and an analyzing component operatively connected to said acoustoelectric transducer for determining three-

dimensional shapes of said objects by analyzing signals generated by said acoustoelectric

transducer in response to second pressure waves produced at said objects in response to said first pressure wave.

75. The imaging device defined in claim 74 wherein at least one of the transducers is

attached at least indirectly to said substrates.

76. The imaging device defined in claim 75 wherein said scanner includes a flexible bag

attached to said substrates and carrying a fluidic medium so that ultrasonic pressure waves can

travel through said fluidic medium from said electroacoustic transducer and to said

acoustoelectric transducer.

77. The imaging device defined in claim 75 wherein said electroacoustic transducer is

one of a plurality of electroacoustic transducers each capable of generating a pressure wave in

plurality of acoustoelectric transducers capable of sensing pressure waves in a plurality of

different frequency ranges.

78. The imaging device defined in claim 68 wherein said video screens include elements

for providing a stereoscopic image to a viewer, said scanner including means for energizing

said elements to produce said stereoscopic image.

79. The imaging device defined in claim 68 wherein said substrates carry a plurality of

electroacoustic transducers attached to said substrates in a predetermined array, said scanner including means for energizing said electroacoustic transducers in a predetermined sequence.

80. The imaging device defined in claim 68 wherein said substrates carry a plurality of

acoustoelectric transducers attached to said substrates in a predetermined array, said scanner

sequence.

81. A medical method comprising:

providing an imaging device including a plurality of planar substrates fastened to one

another by at least one flexible connector, each of said substrates carrying a respective video

screen, a scanner being operatively connected to said video screens; disposing said substrates with said video screens on a body portion of a patient so that

said substrates and said video screens substantially conform to the body portion of the patient

and so that said video screens are facing away from the body portion of the patient; and

after the disposition of said substrates and said video screens on the body portion of the

patient, operating said scanner to provide video signals to said video screens, said video signals

encoding images of internal tissues of the patient.

82. The method defined in claim 81, further comprising operating said video screens to

reproduce said images so that internal tissue representations as displayed on said video screens

substantially overlie respective corresponding actual tissues of the patient.

83. The method defined in claim 82, further comprising placing markers on the patient

for facilitating the reproducing of said images so that the internal tissue representations on said

video screens substantially overlie respective corresponding actual tissues of the patient.

84. The method defined in claim 81 wherein the operating of said scanner to provide

said video images includes automatically analyzing scanner sensor signals and determining therefrom three-dimensional shapes of the internal tissues of the patient.

85. The method defined in claim 84, further comprising highlighting a selected feature

of the internal tissues of the patient on said video screens.

86. The method defined in claim 81 wherein said imaging device is provided with a

plurality of apertures, further comprising:

providing a medical instrument;

apertures;

after insertion of said distal end portion, manipulating said instrument from outside the

patient to perform an operation on at least one of the internal tissues of the patient, said images

being viewed on said video screens while said instrument is being manipulated.

87. The method defined in claim 81 wherein said scanner includes at least one electroacoustic transducer, an a-c current generator operatively connected to said transducer, at least one acoustoelectric transducer and an analyzing component operatively connected to

said acoustoelectric transducer, the disposing of said substrates with said video screens on the body portion of the patient including placing said substrates in pressure- wave-transmitting

contact with the body portion of the patient, the operating of said scanner including:

transmitting a first electrical signal of a pre-established ultrasonic frequency from said

current generator to said electroacoustic transducer for energizing said electroacoustic

transducer to produce a first pressure wave;

transmitting said first pressure wave into the body portion of the patient;

transmitting, from said acoustoelectric transducer to said analyzing component, a

second electrical signal corresponding to a second pressure wave produced at the internal tissues of the patient in response to said first pressure wave; and

operating said analyzing component to determine three-dimensional shapes of the

internal tissues of the patient by analyzing said second electrical signal.

88. The method defined in claim 87 wherein said electroacoustic transducer is one of a

plurality of electroacoustic transducers and said acoustoelectric transducer is one of a plurality

of acoustoelectric transducers, further comprising transmitting a plurality of electrical signals

of different pre-established ultrasonic frequencies from said current generator to said

electroacoustic transducers for energizing said electroacoustic transducers to produce pressure

waves in different ultrasonic frequency ranges, also comprising transmitting, from said

acoustoelectric transducers to said analyzing component, electrical signals corresponding to pressure waves produced at the internal tissues of the patient in response to the pressure waves

in the different ultrasonic frequency ranges, the operating of said analyzing component to

determine three-dimensional shapes of the internal tissues of the patient including analyzing electrical signals from said acoustoelectric transducers.

89. A medical imaging device comprising:

a planar substrate;

a substantially flat video screen provided on said substrate;

a flexible bag connected to said substrate, said bag being disposed on a side of said

substrate opposite said video screen, said bag being filled with a fluidic medium capable of transmitting ultrasonic pressure waves; and

thereto, said video signal encoding an image of internal tissues of a patient upon placement of said flexible bag with said medium, said substrate and said video screen against a patient.

90. The imaging device defined in claim 89 wherein said scanner is an ultrasonic

scanner.

91. The imaging device defined in claim 90 wherein said scanner includes at least one

electroacoustic transducer and at least one acoustoelectric transducer both attached at least

indirectly to said substrate so that ultrasonic pressure waves can travel through said fluidic

medium from said electroacoustic transducer and to said acoustoelectric transducer.

92. The imaging device defined in claim 91 wherein said scanner is provided with an

dimensional shapes of said objects.

93. The imaging device defined in claim 92 wherein said analyzing component includes

means for performing automated diagnoses based in part on image information derived from said scanner sensor signals.