Medical needle for use in ultrasound imaging

Abstract: A needle (1) inserted into body tissue (10) is rendered visible to a Doppler ultrasound imager (9) by generating a longitudinal oscillation of the fluid column in the needle barrel by means of a transducer (7) which is energised by a signal of frequency 100Hz to 2kHz, for example. An image (13) of the needle tip (31) is displayed on a screen (12).

Description: The present invention relates to a hollow medical needle for use in ultrasonic imaging. The theory of ultrasonic transmission in biopsy needles is discussed in ULTRASONICS Vol. 26, No. 1, 1988 pp 27 to 30. US 3,556,079 (Omizo) discloses a medical apparatus comprising a tubular needle within which is mounted an ultrasonic transducer which may be a transmitter, a receiver or a combined transmitter and receiver. This transducer is coupled to saline solution within the needle and transmits and/or detects ultrasound at considerable distances through body tissue at a frequency of e.g. 5MHz which is subsequently reflected off e.g. flowing blood in a blood vessel and shifted in frequency according to the Doppler equation. If the transducer in the needle is a transmitter only, then an external ultrasound receiver is arranged to detect the reflected Doppler-shifted ultrasound which is demodulated to generate an audio signal whose amplitude is a maximum when the needle is directed at the blood vessel. However the above arrangement merely enables the position of the blood vessel or other target to be detected and does not enable the position of the needle to be detected. It could not, for example, be used to direct a needle towards a portion of diseased static tissue. Furthermore it is not an imaging system. Ultrasound imaging utilises the principle of sound reflectivity in order to form images of body organs. These images are displayed on the monitor in grey-scale. Some ultrasound machines also incorporate the principle of Doppler frequency shift which allows moving objects eg red blood cells in a blood vessel to be imaged. Such vessels can then be assigned a colour according to the direction of movement within them, and they appear in colour against the grey-scale background of their environs. It is often desirable to form such an image during treatment with an aspiration or a biopsy needle and it has been found difficult to produce a clearly defined image of the needle by this technique. It has been proposed to apply a transverse vibration to the needle in order to overcome this problem but this does not result in a clear image of the needle tip. GB-A- 2,157,828 discloses an ultrasonic imaging apparatus comprising an inner needle having a miniature ultrasonic transducer mounted at its tip and an outer tubular puncture needle surrounding and supporting the inner needle. An ultrasonic 'imager generates an ultrasonic beam which impinges on the miniature transducer and the resulting electric output signal is either used to trigger a transponder which causes the transducer to emit a predetermined ultrasonic signal which is detectable and locatable by the imager or to enable circuitry in the imager to detect the position of the needle from the time interval between emission and detection of the ultrasonic beam. From this information the position of the needle can be superimposed on the image. However the above arrangement is complex and expensive and in general the needle can be used only with one design of imager. Further background information is provided in US 5,131,394, EP-A-397,960, EP-A-83,973 (which teaches at p. 7 para 1 the desirability of contact between the stylet and the needle) and WO-A-82/03160, which however lies outside the technical field of the present invention. EP-A-453,251 discloses a biopsy needle having a solenoid coil coupled to a core which is mounted directly on the proximal end of the stylet and arranged to reciprocate the stylet longitudinally at a frequency of e.g. up to 100 Hz in order to render the needle tip visible to Doppler ultrasound. The amplitude of vibration is such that the tip of the stylet oscillates between a position in which it is flush with the opening of the cannula and a position in which it is retracted about 1mm into the cannula. However the above arrangement in which the vibratory transducer is directly coupled to the stylet has the disadvantage that movement of the stylet inevitably causes motion of similar amplitude and frequency in the cannula, with the result that the motion is not confined to the needle tip and the Colour Doppler imager assigns a flare of colour to the entire needle. Furthermore the weight of the solenoid makes the needle harder to manipulate, an important point when one considers the degree of accuracy needed to perform certain biopsies. Accordingly the present invention provides a medical apparatus as defined in claim 1 comprising a tubular needle which is adapted for insertion into body tissue, the needle being provided with a transducer which is substantially mechanically isolated from the needle and coupled to a fluid column within the needle, the transducer being arranged to generate a longitudinal oscillation of said fluid column at a sub-ultrasonic (preferably audio) frequency which enhances the visibility of the region of the needle tip to Doppler ultrasound imaging. The transducer is remote from the needle and is coupled to the needle by a flexible tube which contains a further fluid column (preferably an air column) coupled to the transducer. Since the colour of a region of a Doppler ultrasound image is dependent on the velocity of the corresponding region of tissue and this velocity will vary with the amplitude of the oscillation of the end of the fluid column at the needle tip (assuming that the period of the oscillation is fixed) and this amplitude in turn is dependent on the mechanical properties of the tissue being vibrated by the fluid column, the apparatus of the present invention should enable the tissue at the needle tip to be characterised. For example, fatty tumours will vibrate differently from solid lesions and would be expected to generate a different colour response in the Doppler image of the needle tip . The transducer may for example comprise a moving coil loudspeaker coupled to the fluid column in the needle bore by a connecting tube whose cross section decreases towards the needle and thereby amplifies the motion of the loudspeaker diaphragm. Alternatively a thermal transducer such as a spark-gap chamber or a piezoelectric transducer may be used. The optimum frequency of the longitudinal oscillation generated by the transducer of the needle arrangement will depend on the Colour Doppler ultrasonic imager with which it is being used, in particular on the velocity range detectable by the imager. In a typical Colour Doppler ultrasonic imager the minimum detectable velocity will be of the order of ±0.001m/s and a maximum velocity of about ±3.8m/s, with a more usual range being from ±0.02m/s to ±0.6m/s. Accordingly it is believed that the frequency and amplitude of oscillation should be such that the maximum velocity is within the above ranges. With conveniently achievable amplitudes of oscillation, it is believed that the most useful frequencies will be in the audio range i.e. 20Hz to 20 kHz but the invention is by no means limited to the above ranges. Preferred embodiments of the invention are described below by way of example only with reference to the accompanying drawing, wherein: Figure 1 is a diagrammatic representation of a medical apparatus in accordance with the invention, and Figure 2 is a longitudinal cross-section of another needle arrangement for use in the arrangement of Figure 1. Referring to Figure 1, which is a purely diagrammatic representation, a hollow needle 1 is shown inserted into body tissue 10. The needle comprises a tubular cannula 2 having an outside diameter of 0.711mm (0.028") and housing a stylet 3 of 0.457 mm (0.018") diameter within the cannula. The tip of the stylet projects about 2mm beyond the tip 31 of the cannula. The stylet is hollow and has an eccentric opening 32 immediately adjacent to its closed bevelled tip. The eccentric opening, which protrudes beyond the end of the 22 gauge housing cannula, allows the oscillating air column to deliver movement to adjacent tissue while minimising the possibility of body tissue entering the stylet and occluding it. This arrangement allows the tip of the stylet to be rendered visible to Doppler ultrasound during the insertion of the needle through tissue. 8mm flexible pressure tubing 4 connects the hollow stylet with the neck of a funnel member 5 as shown. Alternatively the stylet 3 may optionally be solid and after passage of the needle through tissue, the solid stylet may be removed and the bore of the cannula 2 may be connected directly to the pressure tubing (4') and funnel member as shown in phantom. The mouth of funnel member 5 is coupled in an airtight manner to a moving coil loudspeaker 7 whose diaphragm 6 is driven by a signal from a signal generator 8. Preferably the signal, which may be a pulsed or an oscillating signal, has a period of 0.03s to 0.001s. More preferably the signal has a sine, square or triangular waveform of frequency 333Hz to 1kHz (ideally 400 to 800Hz e.g. 600Hz) and a power of a few (e.g. 100) mW. The body tissue is insonated with an ultrasonic beam 11 by a Doppler ultrasound imager 9, which may for example be an Acuson 128 XP10 imager. An image 13 of the needle tip 31 is formed on a screen 12 of the imager. Example A working model utilising a jelly phantom in place of the body tissue 10 was constructed generally as shown in Figure 1.The components of the working model were as follows: hollow needles, a hollow stylet, a loudspeaker, signal generator and 50cm of 'pressure' tubing. The needles were standard 15cm Chiba needles (Cook Inc., Bloomington Indiana) and the 15cm hollow stylet was made of superelastic nickel titanium alloy with an inner diameter of 0.406mm (0.016") (Raychem Corp., Menlo Pk. Calif.). The speaker coil was modified from a 127mm (5 inch) diameter plastic-coned loudspeaker (Tannoy Ltd., Strathclyde, Scotland) and was connected in an airtight arrangement via a funnel to the hollow stylet. The signal generator used was a Korg 770 synthesiser (Keio Electronic Laboratory Corporation, Tokyo, Japan). This instrument generates square, triangular and rectangular waveforms at a wide range of audio frequencies. The signal was amplified through a Realistic SA 1500 audio amplifier (Tandy Corporation, Fort Worth, Texas). Colour Doppler ultrasound machines used to evaluate the device were an Acuson XP10 (Acuson Ltd.),and a Diasonics Spectra VST (Diasonics Ltd. Milipitas Calif. USA). Testing was done by applying a 3.5MHz probe to a jelly phantom and immobilising it in position. The pressure tubing was then connected directly to the needle barrel (minus its matching solid stylet). The needle was then inserted into the phantom as far as possible. 5MHz and 7.5MHz probes were also used with the needle with similar results. Signal was applied to the needle starting at 1Hz and gradually increasing in frequency until colour signal was registered by the ultrasound machine at a selected pulse repetition frequency and gain setting. Results The needle tip was displayed as a beacon of colour regardless of the angle of incidence of the Doppler beam. Transverse, longitudinal and oblique projections displayed the beacon equally. The colour signal was not constant but was found to change hue and to flicker at varying rates depending on the frequency of the sound wave applied to the needle. This is believed to be caused by an interference pattern at the needle tip between the frequency of motion and the pulse repetition frequency of the incoming Doppler wave. The needle tip was readily detectable when inserted fully into the phantom. This corresponded to a depth of 15cm. No signal other than that at the tip of the needle was registered when the needle was stationary. It was found that a frequency of 600Hz yielded a beacon of signal which was readily detectable at pulse repetition frequencies ranging from 800 to 2250 kHz using the Diasonics machine. Within this range, colour gain values of between 68 and 80 dB were required to demonstrate a visible beacon unaccompanied by colour noise on the screen. There was no visible difference between sine, square, triangular or rectangular waveforms. Many other frequencies were found to generate detectable signal at various pulse repetition frequencies and colour gain settings but 600Hz was the single frequency most likely to be detectable in the range of pulse repetition frequencies described. Increasing gain values above 80dB led to colour noise which could be mistaken for the needle tip. Below a pulse repetition frequency of 800kHz useful signal at the tip uncorrupted by colour noise was demonstrated only at 400Hz with this particular apparatus. Above 2,250 Hz a similar problem occurred with this particular apparatus. Because pulse repetition frequencies are not given a numerical value on the Acuson XP10 display it was not possible to directly correlate the findings between it and the Diasonics Spectra VST. It was found that the Acuson machine was capable of displaying the colour beacon at the tip of the needle as well as the Diasonics although differences in frequency response between these two machines could not be ruled out because the frequency of pulse repetition is not displayed on the Acuson machine. At higher pulse repetition frequencies (greater than 1000Hz) tissue motion 'flash' was not prominent and did not obscure the signal at the needle tip when Doppler interrogation was performed during the process of needle insertion. At pulse repetition frequencies lower than 1000Hz, an increasing amount of tissue flash was seen with needle movement which at the lowest settings e.g. 100Hz was very prominent. It was found that when a tissue or agar phantom was used, the needle accumulated material within it and became blocked during insertion. When this occurred, no colour signal was visible at the tip. Blockage was prevented by using a phantom made of ultrasound coupling jelly. The 0.406mm (0.016") internal diameter hollow stylet was connected to the pressure tubing and inserted into the 0.889mm (20G) outer diameter Chiba needle so that it protruded just beyond its tip to see if it was possible to conduct signal down a lumen of this diameter. Satisfactory colour signal was easily visible at the tip of this hollow stylet, although the size of the beacon was smaller than when the 0.889mm (20G) outer diameter needle barrel was connected directly to the pressure tubing. The volume control of both amplifier and signal generator needed to be at maximum in order for good quality signal to be registered. Accordingly the speaker was housed in a cabinet to minimise unwanted sound output. Reducing the volume caused a corresponding reduction in colour signal on the monitor. Of interest is the observation that slight movement of the transducer off the needle tip resulted in failure to detect any signal. This sensitivity allowed detection of the exact location of the tip of the needle in both colour Doppler and spectral modes. Furthermore the needle tip could be easily found when the probe was displaced far away from the insertion site and aligned randomly with respect to the needle shaft. Referring now to Figure 2, the needle arrangement shown is designed to prevent occlusion of the oscillating fluid column during insertion into the body tissue and comprises a tubular outer cutting sheath 34 housing a trocar 21. Trocar 21 has a recess 14 at its distal end which exposes a retractable tubular stylet 30 which has a radially directed aperture 32 adjacent its forward (distal) tip. The bore of stylet 30 communicates with the funnel arrangement shown in Figure 1 via flexible tubing 4 and consequently the Doppler signal is emitted at aperture 32 throughout the insertion and enables the precise position of the tip portion of the needle arrangement to be detected continuously. In use, first the trocar 21 is advanced together with the stylet 30, the latter having its aperture 32 located in the recess 14 as shown and the outer cutting sheath being retracted as shown. When the recess 14 has been advanced to the required position, as determined with the aid of the Doppler ultrasound image of the stylet tip region, the stylet 30 is withdrawn from the trocar 21 to allow tissue to fill the recess 14 and outer cutting sheath 34 is advanced (from left to right relative to Figure 2) over the trocar to cut off the tissue lying in recess 14. The resulting tissue sample can then be extracted. In this manner a tissue sample (e.g. of a liver lesion) can be taken from an accurately known region of the tissue. In all the arrangements illustrated in the drawings, the stylet, cannula and trocar (if used) as well as the flexible tubing are sterilised and may be disposable. The invention also provides a medical apparatus comprising a tubular needle which is adapted for insertion into body tissue, the needle being provided with a transducer which is substantially mechanically isolated from the needle and coupled to a fluid column within the needle, the transducer being arranged to generate a longitudinal oscillation of said fluid column at a non-ultrasonic frequency which enhances the visibility of the needle tip to Doppler ultrasound imaging. The invention also extends to every novel combination or sub-combination disclosed herein.

Claims: Medical apparatus comprising a tubular needle (1) adapted for insertion into body tissue (10), and having a fluid column therein to be vibrated by an emitter transducer (7), whereby the vibrations are detectable by a receiver transducer (9), characterised in that the apparatus further comprises a flexible tube (4) for connecting the needle to the emitter transducer (7), the latter being a sub ultrasonic emitter to be remotely located from the needle, and in that the receiver transducer is an ultrasound Doppler imager for enhancing the image of the needle tip. Apparatus according to claim 1 wherein said sub-ultrasonic frequency is an audio frequency. Apparatus according to claim 1 or claim 2 wherein the flexible tube (4) serves to contain a further fluid column coupled to the transducer. Apparatus according to claim 3 wherein the transducer (7) comprises a moving coil loudspeaker coupled to the fluid column in the needle (1) by a funnel member (5) whose cross-section decreases towards the needle (1) and thereby amplifies the motion of the loudspeaker diaphragm (6). Apparatus according to any preceding claim wherein the needle (1) comprises a tubular stylet (3/30), the stylet is located within a cannula (2) or trocar (21) and said transducer (7) is coupled to the first mentioned fluid column within the stylet and substantially isolated from the stylet. Apparatus according to claim 5 wherein the stylet (3/30) has an aperture (32) at its distal end which communicates with its bore and is located and dimensioned to substantially prevent its occlusion by body tissue (10) in use. Apparatus according to claim 4, wherein the loudspeaker is controllable by an amplifier to vary the amplitude of the oscillation of the fluid column in the needle (1) in dependence upon the mechanical properties of the body tissue (10) at the needle tip (31). Apparatus according to any preceding claim comprising an electric signal source (8) arranged to energise said transducer (7) with a drive signal having a pulsed or oscillating waveform whose period is 0.03 second to 0.001 second. A Doppler ultrasound arrangement comprising an apparatus as claimed in any preceding claim, the Doppler ultrasound imager (12) being arranged to insonate at least the region of the needle tip (31) with ultrasound having a frequency higher than the frequency of said longitudinal oscillation and to form an image (13) of the region of said needle tip.

Inventors: COCKBURN DONALD, COCKBURN JOHN FRANCIS DR, COCKBURN, DONALD, COCKBURN, JOHN FRANCIS, DR.
Applicants: COCKBURN DONALD, COCKBURN JOHN F, COCKBURN, DONALD, COCKBURN, JOHN FRANCIS, DR.
Application year: 1995
Main classification: A61B8
IPC codes: A61B17, A61B8, A61B19, G10K11, A61B10