Portable 3-D ultrasound offers

expert battlefield diagnoses

By AVIVA L. BRANDT

Associated Press Writer

RICHLAND, Wash. (AP) _ Rik Littlefield grimaced in concentration, one hand manipulating an imaginary probe in the air as he mimicked the doctors he had watched test a portable ultrasound device.

The device, which can be bundled into an 85-pound backpack load, makes possible expert diagnoses on the battlefield _ enabling on-site technicians to perform ultrasound imaging scans and transmit the data anywhere in the world for interpretation.

"The illusion that this thing is a real ultrasound probe is so good that a person experienced with ultrasounds can start making diagnoses within five minutes," said Littlefield, project manager at Battelle's Pacific Northwest National Laboratory for the device known as MUSTPAC, short for Medical Ultrasound, Three-dimensional and Portable with Advanced Communications.

All the person at the scene needs to know is the general area of the injury or health problem. It's up to the professionals to interpret the blurry shades of gray the device transmits to their computer screen, he said.

MUSTPAC was tested last month on soldiers in Bosnia who also received conventional ultrasound exams. The data, stored in the computer for transmission via telephone line or satellite, was interpreted by doctors in Germany.

Scientists at the lab here, working with medical technology experts from the Army, adapted existing technology to create the device, Littlefield said.

His inspiration was to use a $1,500 device intended for virtual reality games _ combining it with a plastic simulation of the hand-held probes used to perform traditional ultrasounds.

Doctors interpreting the data can manipulate the probe to change the view of the ultrasound on the computer screen. They can move the probe just as they would if they had it against the patient's body, Littlefield said.

"For the first couple minutes they're distracted by the machine. They play with it and complain about how it's different," he said, gesturing as though he held one of the plastic probes.

"But there was not a single doctor or technician who within five minutes did not forget completely about the probe and concentrate on the data."

It was important to make the device easy to use because it takes at least two full years of specialized study to learn how to interpret ultrasound images, which are created by sending high frequency sound waves into the body.

MUSTPAC also offers three-dimensional images. While that capacity is available in some hospitals, the standard ultrasound produces a two-dimensional image.

That feature helped save the life of a pregnant woman treated at Madigan Army Medical Center in Tacoma, said Sam Stevens, team leader of the lab's medical technology group.

The woman received a standard fetal ultrasound, which confirmed doctors' belief that the placenta had grown over part of the cervix. But it appeared the blockage could simply be moved out of the way for a vaginal birth, Stevens said.

She then gave permission for a MUSTPAC scan. Its three-dimensional image gave doctors a broader view than the standard two-dimensional ultrasound and showed that her uterus had grown toward her bladder, he said.

"Had the woman gone ahead and had a traditional birth, there was a strong possibility she could have had a rupture to her bladder and she could have bled to death," Stevens said.

"Instead, the woman delivered C-section, and today, both mother and child are fine."

The project is funded by a $5.2 million grant from the U.S. Department of Defense's Defense Advanced Research Projects Agency. Already cleared by the Food and Drug Administration for clinical tests, it is expected to win approval for military use within a year.

Littlefield predicts MUSTPAC will win FDA approval for civilian use within four years.

For one thing, it offers unprecedented opportunity for follow-up interpretation and reconsideration of results.

A hospital ultrasound is performed by a technician whose expertise determines "exactly where to put probe and how to interpret what he's looking at," Littlefield said.

"You end up with 12 or so snapshots showing a little piece of the patient's anatomy. If you bring in another expert, that's all they have to look at to make a diagnosis unless they bring the patient back and do their own scan," Littlefield said.

But with MUSTPAC's computer storage of 3-D images, "We give him the ability to use that original ultrasound information but to view it like he's doing his own procedure.

"He's not just limited to those snapshots the technician thought were key," Littlefield said.