Jan 2012

General Applications on Biomedical Acoustics

Highlighted on ultrasound applications
Ahmed El Sayed Ahmed El Sayed Mohamed Mostafa Mahmoud Ayesh Nour Hamdy Seif
Abstract this paper presents basic definition about medical

acoustic, how sounds are generated in a human body and wide range of potential applications of medical acoustics in diagnosing and treating different diseases especially how doctors can diagnose these diseases such as inner bleeding, teeth cleaning, also diagnosis of lung and cardiac system using the most basic device in medical field stethoscope - and the most widely used method this days ultrasound. I. INTRODUCTION

Acoustics is the interdisciplinary science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound , Biomedical acoustics , Medical acoustics covers the use of sub-audio vibration, audible sound and ultrasound for medical diagnostics and treatment and could be divided into diagnosis and therapy , Diagnosis separated into auditory method that uses auscultation with stethoscope and ultrasound (both employ low amplitudes). Therapy use ultrasound to treat some medical diseases such as destruction of kidney stones, II.
DIAGNOSING USING STETHOSCOPE

airways. These are large, low-frequency oscillations that cause the surrounding tissues to vibrate within the audible frequency range. The respiratory system is naturally optimized to minimize the work needed to exchange air, so little energy is converted into acoustic power, resulting in low-amplitude sounds. With constriction of the airways, in such conditions as asthma, the air velocity through the airways increases (conservation of mass). Through conservation of energy and momentum, an increase in flow velocity results in an increase in pressure loss, raising the power needed to drive the system. The energy is of course not lost, but converted, in part, into acoustic power. [1]

Sounds in the body are generated through the presence of disturbed flow of air or blood, such as eddies and turbulence, by frictional rubs. There are both normal and abnormal sounds within the body. Auscultation is the act of listening sounds within the body for diagnostic purposes. This may be conducted on any part of the body from head to toe (Fig. 1.1). [1] A murmur is a sound lasting longer than 10ms heard by a cardiologist from the heart, valve sounds and heart murmurs are primarily heard in the peristernal intercostal spaces indicating valve stenosis. A bruit is a similar sound, but heard by an angiologist from an artery. Breath sounds in the lung indicate, lung inflation, alveolar inflation. Crepitus on motion indicates air in the tissue, bone fracture or joint this air generates sound to be detected. Fig.1 Auscultation sites [1] sec.21.1 page 843 B. The Cardiac diagonsis: The cardiovascular system also generates normal and abnormal sounds that can be heard in the chest with a stethoscope. Bl. Normal heart sounds have frequency 50Hz and caused by rapid blood decelerations resulting from the closure of the heart valves. Each of the four heart valves, the tricuspid,

A. Diagonsis of lung: Both normal and abnormal sounds can be presented in the lungs. The source of normal lung sounds is turbulent flow associated with air movement through orifices along the

Jan 2012 mitral, pulmonic and aortic are flaccid sheets of tissue securely tethered in the closed position to form check (oneway) valves. Though four valves are present, usually only two thumps are heard, and they occur at vary precise times in the cardiac cycle. 20 ms after the onset of ventricular contraction, the tricuspid and mitral valves close, causing the first heart sound, often described as a DUB. 50 mS after closure of the atrio-ventricular valves, the pulmonic and aortic valves open silently. 320 ms after the onset of ventricular contraction, when ventricular ejection is complete and the ventricular pressures drop below the pulmonary trunk and aortic pressures, the pulmonic and aortic valves snap shut, generating the second heart sound. Bll. Abnormal sounds have frequency around 100Hz and occur in the cardiovascular system such as bruits and murmurs .Veins rarely make sounds. A functional murmur or "physiologic murmur" is a heart murmur that is primarily due to physiologic conditions outside the heart, as opposed to structural defects in the heart itself. Murmurs can be classified different characteristics: timing, shape, location, radiation, intensity, pitch and quality. Timing refers to whether the murmur is a systolic or diastolic murmur. Shape refers to the intensity over time; murmurs can be crescendo, decrescendo or crescendo-decrescendo. Location refers to where the heart murmur is usually auscultated best. Propagation refers to where the sound of the murmur originates. Pitch can be low, medium or high and is determined by whether it can be auscultated best with the stethoscope. Heart murmurs are graded from grade 1 (barely audible) to grade 6 (no stethoscope needed). [1] C. The Artial diagonsis: Bruits are almost always associated with stenosis in arteries, which often require treatment. They are classified by their pitch and duration. The occurrence of bruits in the head, in the abdomen after eating and in the legs is all indications of arterial stenosis, or high-velocity blood entering vascular dilations. The presence of a bruit heard in the neck is usually indicative of a carotid stenosis. [1] III. ULTRASOUND ACOUSTICS It is sound pressure with a frequency greater than the upper limit of human hearing. The upper frequency limit in humans (approximately 20 kHz) is due to limitations of the middle ear, which acts as a low-pass filter. Ultrasonic hearing can occur if ultrasound is fed directly into the skull bone and reaches the cochlea through bone conduction without passing through the middle ear. Ultrasound has many applications in the field of biomedical A. Sonography (ultrasonography) Medical sonography (ultrasonography) is an ultrasound-based diagnostic medical imaging technique used to visualize muscles, tendons, and many internal organs, to capture their size, structure and any pathological lesions with real time tomographic images Sonophoresis, which uses sound waves instead of needles to inject drugs such as insulin and interferon through the skin. The high-frequency waves open tiny holes in cell membranes, thus rendering the cells temporarily permeable in localized regions and allowing better penetration of the drug into the blood vessels below the skin The technology is relatively inexpensive and portable, especially when compared with other techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT) Sonography is generally described as a "safe test" because it does not use mutagenic ionizing radiation, which can pose hazards such as chromosome breakage and cancer development Typical diagnostic sonographic scanners operate in the frequency range of 2 to 18 megahertz The choice of frequency is a trade-off between spatial resolution of the image and imaging depth: lower frequencies produce less resolution but image deeper into the body. Higher frequency sound waves have a smaller wavelength and thus are capable of reflecting or scattering from smaller structures. Higher frequency sound waves also have a larger attenuation coefficient and thus are more readily absorbed in tissue, limiting the depth of penetration of the sound wave into the body. [2] B. medical imaging Different modes of sonography: i. ii. A-mode B-mode

iii. C-mode iv. M-mode v. Doppler mode E.g. B-mode is used to diagnose pregnancy at 6 weeks (counted from the first day of the last menstrual period) and afterwards. This avoids the need for X-rays and the attendant danger of irradiation to mother and child C. Lithotripsy of Kidney Stones Extracorporeal shock wave lithotripsy has completely changed the treatment of kidney Commercial and Medical Ultrasound Applications stones. Kidney stones are calcified particles that

Jan 2012 Fig.2 operation on kidney Lithotripsy tend to block the urinary tract. In this type of treatment, the patient is immersed in water to equalize as much as possible the acoustic impedances between the transducer and the patients body. [2] frequency typically being at 15 MHz. This method can outline tumors, and detached retinas, measuring the length of the axis of the eye, and detect foreign bodies close to the posterior eye wall. One instrument combines a diagnostic transducer for locating foreign bodies with a surgical instrument for removing an object, which enables rapid removal of foreign bodies from the eye by directing the surgical tool to the object with least damage to the eye J. Neurology Ultrasonic echoencephalography provides an immediate means of detecting lateral shifts in the midline septum caused by tumors or concussion. Every emergency ambulance in Japan is outfitted with echo-encephalographic equipment in order to identify victims with possible subdural hemorrhage so that they may be transported directly to special neurological units for treatment. [2] K. Gene therapy Gene therapy is a technique for the purpose of correcting or preventing a disease by delivering genes into an individual's cells and tissues. Ultrasound- enhanced gene delivery using polymers or other non-viral vectors, though also in its preclinical stage may hold a lot of promise for the future. [5] L. 3D ultrasound 3D ultrasound is a medical ultrasound technique, often used in obstetric ultrasonography (during pregnancy), providing three dimensional images of the fetus. [2] M. Low-frequency therapy Low-frequency therapy is a sort of physiotherapy intended to help to relieve acute or chronic pains caused by stiffness or fatigue in the manner of applying low frequency to the human body, massaging directly the muscles with the stimulations, inducing nervous sedation and promoting the circulation of blood. In addition, this therapy causes muscular contraction, improving the resistance to physical weakness, obesity and diseases. Recently, it has been also used in obesity control machines on the basis of the principle of vibrating adipose cells. [1] N. The Lung Flute tube An easy-to-use device developed for patients suffering from chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. The Lung Flute, one of Popular Science magazines best 100 innovations of 2009, is a hand-held device that employs sound wave technology to break up mucus in the lungs. [3] IV. CONCLUSIONS

D. Thrombolysis by ultrasound New method of destroying thrombi in blood vessels by ultrasound [1] E. High-Intensity Focused Ultrasound (HIFU) The ultrasound focused by a specially shaped set of transducers converges inside the body to create a region of intense heat that can destroy tumor cells. The spot of destruction is so small that a boundary of only six cells lies between the destroyed tissue and completely unharmed tissue, which connotes a precision far beyond any current method of surgical incision The focused ultrasound waves, , can penetrate deeply into the organ and cook the tissue in a layer as thin as 1 mm. It follows that trauma patients could be treated without the need for a sterile environment of an operating room and without the danger of infection that accompanies conventional surgery [1]

F. Echocardiogram This is a study of the heart using ultrasound. A bubble echocardiogram is an extension of this that uses simple air bubbles as a contrast medium during this study and often has to be requested specifically. Although color Doppler can be used to detect abnormal flows between the chambers of the heart (e.g. patent foramen ovale) it has a limited sensitivity. When specifically looking for a defect such as this small air bubbles can be used as a contrast medium and injected intravenously, where they travel to the right side of the heart. The test would be positive for an abnormal communication if the bubbles are seen passing into the left side of the hear G. Teeth cleaning Some techniques, such as the use of 25 kHz ultrasound combined with a water jet to remove plaque from teeth and the cleaning of dental and medical tools with ultrasound H. Stop bleeding Ultrasound can also be used to stop internal bleeding through an effect called acoustic hemostasis. With sufficient power, ultrasonic pulses can elevate the body temperature at selected sites from 37C to between 70C and 90C in an extremely short time, less than 1 second [1] I. Eye diagnosing Accurate diagnosis is rendered possible in the field of ophthalmology through the use of ultrasound to diagnose conditions existing in the soft tissues of the orbit of the lightopaque portions of the eye. Focused transducers are used with

Ultrasound is now accepted as being of considerable diagnostic value. There is no evidence that diagnostic ultrasound has produced any harm to patients in the four decades that it has been in use.

Jan 2012 Ultrasonic methods are now proving extremely useful for examining both the macro- and microstructure of such system. [5]

V.

REFERENCES

[1] Thomas D.Rossing, Handbook of Acoustics, Springer, 2007, pages 843-847, 889-894 [2] Daniel R. Raichel, THE SCIENCE AND APPLICATIONS OF ACOUSTICS, Springer, 2006, pages 497-506 [3] Sanjay Sethi, UB professor of medicine, Medical Acoustics, UB reaching COPD patients with lung flute, published: September 8, 2011 [4] William J. Fry, The Journal of the acoustical society of America, Biological and Medical Acoustics, volume 30, number 5, may 1958. [5] Cheng-Huang Su2,3, Hung-I Yeh1,2,3, Charles Jia-Yin Hou2, Yu-San Cheu2, and Cheng-Ho Tsai1,2,3Ultrasoundbased and Non-viral Technologies in Gene Therapy.