Patent Publication Number: US-11647983-B2

Title: Automating ultrasound examination of a vascular system

Description:
BACKGROUND 
     The present invention relates to the electrical, electronic and computer arts, and more specifically, to medical ultrasound examination equipment. 
     Medical ultrasound examination equipment has developed rapidly over the past 30 years and is now used routinely for assessment of arterial stenosis, venous incompetence and venous thrombosis. Ultrasound images are obtained by holding a probe on a patient&#39;s skin surface. An ultrasonic scanner typically has a range of probes with different characteristics, and for lower limb vascular scanning a linear array probe is normally used. This produces a rectangular image, which is displayed with the skin surface at the top, the vertical axis showing depth into the body and the horizontal axis showing position along the probe. 
     A duplex ultrasound combines traditional ultrasound with Doppler ultrasound. Traditional ultrasound, sometimes called B-scan, uses sound waves that bounce off blood vessels to create pictures. Doppler ultrasound records sound waves reflecting off moving objects, such as blood, to measure their speed and other aspects of how they flow. Duplex ultrasound combines Doppler flow information and conventional imaging information to allow physicians to see the structure of the blood vessels as well as how blood is flowing through the vessels. 
     SUMMARY 
     Vascular ultrasound exams require repetitive, time-consuming steps that impact productivity. Conventional ultrasound exam protocols rely entirely on the training and experience of an ultrasound operator to find and trace the correct blood vessels to be examined. The process depends on human expertise to link and create the full picture and decide on the flow of the examination process (moving the ultrasound scanner along the blood vessel). 
     Accordingly, principles of the invention provide techniques for automating ultrasound examination of a vascular system. 
     In one exemplary aspect, a computer-implemented method includes a step of determining an optimal position for placement of an ultrasound scanner on a patient&#39;s body, in response to at least a camera image, a database of human anatomy, an exam procedure, and patient information. The method also includes a step of guiding the ultrasound scanner to the optimal position for placement. 
     In another exemplary aspect, a computer-implemented method includes a step of obtaining, at a processor operatively coupled in communication with a camera, a camera image of a patient&#39;s body within a space marked by fiducials. The method also includes a step of calculating, in the processor, based on the camera image, a 3-D model of the patient&#39;s body with reference to the fiducials. Further, the method includes a step of establishing, in the processor, based on a vascular exam to be performed and with reference to a 3-D template of human anatomy, a template starting position for placing an ultrasound scanner on the 3-D template. Additionally, the method includes a step of mapping, in the processor, the template starting position from the 3-D template to a modeled starting position on the 3-D model of the patient&#39;s body. Further, the method includes a step of determining, in the processor, coordinates of the modeled starting position with reference to the fiducials; and a step of guiding the ultrasound scanner to the coordinates of the modeled starting position. 
     One or more exemplary aspects of the invention provide a computer-implemented method that includes a step of obtaining a camera image of a patient&#39;s body within a space marked by fiducials. The method also includes a step of obtaining an ultrasound image of a vascular structure within the patient&#39;s body. The method also includes a step of calculating, based on the camera image, a 3-D model of the patient&#39;s body with reference to the fiducials, including coordinates of an ultrasound scanner within the 3-D model. Further, the method includes a step of establishing a path of the vascular structure within the 3-D model, based on the ultrasound image and the coordinates of the ultrasound scanner within the 3-D model. Then the method includes a step of determining coordinates of a next optimal position for the ultrasound scanner, based on the path of the vascular structure and a vascular exam procedure to be performed; and a step of guiding the ultrasound scanner to the coordinates of the next optimal position. 
     One or more exemplary embodiments of the invention provide an apparatus, which includes a memory storing computer executable instructions; a camera; an ultrasound scanner; and at least one processor, coupled to the memory. The at least one processor is configured according to the computer executable instructions to facilitate a method. The method includes a step of obtaining from the camera a camera image of a patient&#39;s body within a space marked by fiducials, as well as a step of calculating, based on the camera image, a 3-D model of the patient&#39;s body with reference to the fiducials. The method further includes a step of establishing, based on a vascular exam to be performed and with reference to a 3-D template of human anatomy, a template starting position for placing an ultrasound scanner on the 3-D template. The method also includes a step of mapping the template starting position from the 3-D template to a modeled starting position on the 3-D model of the patient&#39;s body, and a step of determining coordinates of the modeled starting position within the 3-D model with reference to the fiducials. Additionally, the method includes a step of guiding the ultrasound scanner to the coordinates of the modeled starting position. 
     One or more exemplary embodiments of the invention provide an apparatus, which includes a memory storing computer executable instructions; a camera; an ultrasound scanner; and at least one processor, coupled to the memory, and configured according to the computer executable instructions to facilitate a method. The method includes a step of obtaining from the camera a camera image of a patient&#39;s body within a space marked by fiducials, and includes a step of obtaining from the ultrasound scanner an ultrasound image of a vascular structure within the patient&#39;s body. The method also includes a step of calculating, based on the camera image, a 3-D model of the patient&#39;s body with reference to the fiducials, including coordinates of the ultrasound scanner within the 3-D model. The method also includes a step of establishing a path of the vascular structure within the 3-D model, based on the ultrasound image and the coordinates of the ultrasound scanner within the 3-D model. Additionally, the method includes a step of determining coordinates within the 3-D model of a next optimal position for the ultrasound scanner, based on the path and the vascular exam procedure to be performed. Finally, the method includes a step of guiding the ultrasound scanner to the coordinates of the next optimal position. 
     As used herein, “facilitating” an action includes performing the action, making the action easier, helping to carry the action out, or causing the action to be performed. Thus, by way of example and not limitation, instructions executing on one processor might facilitate an action carried out by instructions executing on a remote processor, by sending appropriate data or commands to cause or aid the action to be performed. For the avoidance of doubt, where an actor facilitates an action by other than performing the action, the action is nevertheless performed by some entity or combination of entities. 
     One or more embodiments of the invention or elements thereof can be implemented in the form of a computer program product including a computer readable storage medium with computer usable program code for performing the method steps indicated. Furthermore, one or more embodiments of the invention or elements thereof can be implemented in the form of a system (or apparatus) including a memory, and at least one processor that is coupled to the memory and operative to perform exemplary method steps. Yet further, in another aspect, one or more embodiments of the invention or elements thereof can be implemented in the form of means for carrying out one or more of the method steps described herein; the means can include (i) hardware module(s), (ii) software module(s) stored in a computer readable storage medium (or multiple such media) and implemented on a hardware processor, or (iii) a combination of (i) and (ii); any of (i)-(iii) implement the specific techniques set forth herein. 
     Techniques of the present invention can provide substantial beneficial technical effects. For example, one or more embodiments provide one or more of: 
     Automated guidance for initial placement of an ultrasound probe on a patient&#39;s anatomy. 
     Real-time alerting of vascular abnormality. 
     Automated guidance for probe traversal along a patient&#39;s vasculature. 
     These and other features and advantages of the present invention will become apparent from the following detailed description of illustrative embodiments thereof, which is to be read in connection with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    depicts a cloud computing environment according to an embodiment of the present invention; 
         FIG.  2    depicts abstraction model layers according to an embodiment of the present invention; 
         FIG.  3    depicts an ultrasound exam apparatus including an intelligent vascular exam assistant system, and a method of examination that is implemented by the apparatus, according to one or more exemplary embodiments of the invention; 
         FIG.  4    depicts a method for guiding an ultrasound scanner to an optimal starting position on the patient&#39;s body, using a laser, according to embodiments of the invention; 
         FIG.  5    depicts a method for guiding an ultrasound scanner to an optimal starting position on the patient&#39;s body, using a visual display, according to one or more exemplary embodiments of the invention; 
         FIG.  6    depicts a method for guiding an ultrasound scanner to an optimal starting position on the patient&#39;s body, using an audio signal, according to one or more exemplary embodiments of the invention; 
         FIG.  7    depicts a method for guiding an ultrasound scanner to a next optimal position along a vascular structure, using a laser, according to one or more exemplary embodiments of the invention; 
         FIG.  8    depicts a method for guiding an ultrasound scanner to a next optimal position along a vascular structure, using a visual display, according to one or more exemplary embodiments of the invention; 
         FIG.  9    depicts a method for guiding an ultrasound scanner to a next optimal position along a vascular structure, using an audio signal, according to one or more exemplary embodiments of the invention; and 
         FIG.  10    depicts a computer system that may be useful in implementing one or more aspects and/or elements of the invention, also representative of a cloud computing node according to one or more exemplary embodiment of the present invention. 
     
    
    
     DETAILED DESCRIPTION 
     It is understood in advance that although this disclosure includes a detailed description on cloud computing, implementation of the teachings recited herein are not limited to a cloud computing environment. Rather, embodiments of the present invention are capable of being implemented in conjunction with any other type of computing environment now known or later developed. 
     Cloud computing is a model of service delivery for enabling convenient, on-demand network access to a shared pool of configurable computing resources (e.g. networks, network bandwidth, servers, processing, memory, storage, applications, virtual machines, and services) that can be rapidly provisioned and released with minimal management effort or interaction with a provider of the service. This cloud model may include at least five characteristics, at least three service models, and at least four deployment models. 
     Characteristics are as follows: 
     On-demand self-service: a cloud consumer can unilaterally provision computing capabilities, such as server time and network storage, as needed automatically without requiring human interaction with the service&#39;s provider. 
     Broad network access: capabilities are available over a network and accessed through standard mechanisms that promote use by heterogeneous thin or thick client platforms (e.g., mobile phones, laptops, and PDAs). 
     Resource pooling: the provider&#39;s computing resources are pooled to serve multiple consumers using a multi-tenant model, with different physical and virtual resources dynamically assigned and reassigned according to demand. There is a sense of location independence in that the consumer generally has no control or knowledge over the exact location of the provided resources but may be able to specify location at a higher level of abstraction (e.g., country, state, or datacenter). 
     Rapid elasticity: capabilities can be rapidly and elastically provisioned, in some cases automatically, to quickly scale out and rapidly released to quickly scale in. To the consumer, the capabilities available for provisioning often appear to be unlimited and can be purchased in any quantity at any time. 
     Measured service: cloud systems automatically control and optimize resource use by leveraging a metering capability at some level of abstraction appropriate to the type of service (e.g., storage, processing, bandwidth, and active user accounts). Resource usage can be monitored, controlled, and reported providing transparency for both the provider and consumer of the utilized service. 
     Service Models are as follows: 
     Software as a Service (SaaS): the capability provided to the consumer is to use the provider&#39;s applications running on a cloud infrastructure. The applications are accessible from various client devices through a thin client interface such as a web browser (e.g., web-based email). The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, storage, or even individual application capabilities, with the possible exception of limited user-specific application configuration settings. 
     Platform as a Service (PaaS): the capability provided to the consumer is to deploy onto the cloud infrastructure consumer-created or acquired applications created using programming languages and tools supported by the provider. The consumer does not manage or control the underlying cloud infrastructure including networks, servers, operating systems, or storage, but has control over the deployed applications and possibly application hosting environment configurations. 
     Infrastructure as a Service (IaaS): the capability provided to the consumer is to provision processing, storage, networks, and other fundamental computing resources where the consumer is able to deploy and run arbitrary software, which can include operating systems and applications. The consumer does not manage or control the underlying cloud infrastructure but has control over operating systems, storage, deployed applications, and possibly limited control of select networking components (e.g., host firewalls). 
     Deployment Models are as follows: 
     Private cloud: the cloud infrastructure is operated solely for an organization. It may be managed by the organization or a third party and may exist on-premises or off-premises. 
     Community cloud: the cloud infrastructure is shared by several organizations and supports a specific community that has shared concerns (e.g., mission, security requirements, policy, and compliance considerations). It may be managed by the organizations or a third party and may exist on-premises or off-premises. 
     Public cloud: the cloud infrastructure is made available to the general public or a large industry group and is owned by an organization selling cloud services. 
     Hybrid cloud: the cloud infrastructure is a composition of two or more clouds (private, community, or public) that remain unique entities but are bound together by standardized or proprietary technology that enables data and application portability (e.g., cloud bursting for load balancing between clouds). 
     A cloud computing environment is service oriented with a focus on statelessness, low coupling, modularity, and semantic interoperability. At the heart of cloud computing is an infrastructure comprising a network of interconnected nodes. 
     Referring now to  FIG.  1   , illustrative cloud computing environment  50  is depicted. As shown, cloud computing environment  50  includes one or more cloud computing nodes  10  with which local computing devices used by cloud consumers, such as, for example, personal digital assistant (PDA) or cellular telephone  54 A, desktop computer  54 B, laptop computer  54 C, and/or automobile computer system  54 N may communicate. Nodes  10  may communicate with one another. They may be grouped (not shown) physically or virtually, in one or more networks, such as Private, Community, Public, or Hybrid clouds as described hereinabove, or a combination thereof. This allows cloud computing environment  50  to offer infrastructure, platforms and/or software as services for which a cloud consumer does not need to maintain resources on a local computing device. It is understood that the types of computing devices  54 A-N shown in  FIG.  1    are intended to be illustrative only and that computing nodes  10  and cloud computing environment  50  can communicate with any type of computerized device over any type of network and/or network addressable connection (e.g., using a web browser). 
     Referring now to  FIG.  2   , a set of functional abstraction layers provided by cloud computing environment  50  ( FIG.  1   ) is shown. It should be understood in advance that the components, layers, and functions shown in  FIG.  2    are intended to be illustrative only and embodiments of the invention are not limited thereto. As depicted, the following layers and corresponding functions are provided: 
     Hardware and software layer  60  includes hardware and software components. Examples of hardware components include: mainframes  61 ; RISC (Reduced Instruction Set Computer) architecture based servers  62 ; servers  63 ; blade servers  64 ; storage devices  65 ; and networks and networking components  66 . In some embodiments, software components include network application server software  67  and database software  68 . 
     Virtualization layer  70  provides an abstraction layer from which the following examples of virtual entities may be provided: virtual servers  71 ; virtual storage  72 ; virtual networks  73 , including virtual private networks; virtual applications and operating systems  74 ; and virtual clients  75 . 
     In one example, management layer  80  may provide the functions described below. Resource provisioning  81  provides dynamic procurement of computing resources and other resources that are utilized to perform tasks within the cloud computing environment. Metering and Pricing  82  provide cost tracking as resources are utilized within the cloud computing environment, and billing or invoicing for consumption of these resources. In one example, these resources may include application software licenses. Security provides identity verification for cloud consumers and tasks, as well as protection for data and other resources. User portal  83  provides access to the cloud computing environment for consumers and system administrators. Service level management  84  provides cloud computing resource allocation and management such that required service levels are met. Service Level Agreement (SLA) planning and fulfillment  85  provide pre-arrangement for, and procurement of, cloud computing resources for which a future requirement is anticipated in accordance with an SLA. 
     Workloads layer  90  provides examples of functionality for which the cloud computing environment may be utilized. Examples of workloads and functions which may be provided from this layer include: mapping and navigation  91 ; software development and lifecycle management  92 ; virtual classroom education delivery  93 ; data analytics processing  94 ; transaction processing  95 ; and an intelligent vascular exam assistant system (“I-VEAS”)  96 . 
       FIG.  3    depicts an ultrasound exam apparatus  200  that incorporates the I-VEAS  96 , and a method of examination  300  that is implemented by the system  200 , according to one or more exemplary embodiments of the invention. Within the apparatus  200 , the I-VEAS  96  is operatively coupled in communication with ancillary devices and databases. According to one or more embodiments, the I-VEAS  96  is implemented in a computing system  12  (further described below with reference to  FIG.  10   ). With reference to  FIG.  10    the computing system  12  is described as being incorporated in a node  10  of the cloud computing system  50 , however, in one or more exemplary embodiments the computing system  12  is a stand-alone component of the apparatus  200 . 
     The ancillary devices to the I-VEAS  96  include a traditional ultrasound probe  201 , which provides data related to vascular structure; a Doppler ultrasound probe  202 , which provides data related to blood flow; and a camera  203 , which provides a camera image  302  of the patient&#39;s body. 
     The traditional (“B-scan”) ultrasound probe  201  transmits and receives sound waves that bounce off blood vessels, and is operatively coupled in communication with a computer that measures the sound wave echo times to create two-dimensional images that allow an operator (and the I-VEAS  96 ) to see the structure of the blood vessels. The Doppler ultrasound probe  202  transmits and records sound waves reflecting off moving objects (such as blood cells), and is operatively coupled in communication with a computer that measures the sound wave echo times and frequency shifts to determine the speed of the blood cells and other aspects of how they flow. Together, the traditional and Doppler ultrasound probes provide data that show the operator (and the I-VEAS  96 ) how blood is flowing through the vessels. In one or more embodiments, the two ultrasound probes  201 ,  202  are housed in a common housing. The common housing will hereafter be referred to as an ultrasound scanner  214 . The ultrasound scanner  214  can be handheld by an operator or can be moved by a robotic arm in response to computer instructions, for example in response to the movements of a remote operator in telemedicine or the like. According to one or more embodiments, the ultrasound scanner  214  may be moved by computer instructions that are generated in response to the I-VEAS  96  generating a series of optimal positions for placing the ultrasound scanner. 
     As will be further discussed hereafter, the I-VEAS  96  uses the camera image  302  in guiding an operator of the apparatus  200  to correctly position the ultrasound scanner. 
     The ancillary devices also include a laser  207 , which can be utilized to illuminate the patient; a display  208 , which can be utilized to provide text or image information to an operator of the I-VEAS  96 ; and a speaker  209 , which can be utilized to provide an audio signal to the operator. According to one or more embodiments, the display  208  may be incorporated into an augmented reality (AR) or virtual reality (VR) headset. A VR headset display  208  may be particularly helpful in telemedicine embodiments of the invention. The databases include human anatomy  204 , vascular exams procedures  205 , and patient information  206 . In one or more embodiments, the human anatomy database  204  is structured as a 3-D template of a statistically averaged body with “normal” vasculature. 
     The I-VEAS  96  is a cognitive computing system. That is, the I-VEAS  96  is a computer or network of computers configured to understand (read unstructured data, such as ultrasound images, and extract information), to reason (build hypothesis about which way to move an ultrasound scanner), and to learn (uses machine learning techniques to learn from data, such as whether an operator&#39;s movement of the ultrasound scanner tracks a target blood vessel). Generally, the I-VEAS  96  includes one or more computer processors that are configured to work together to implement one or more machine learning algorithms. The implementation may be synchronous or asynchronous. In the I-VEAS  96 , the processor(s) simulate thousands or millions of neurons, which are connected by axons and synapses. Each connection is enforcing, inhibitory, or neutral in its effect on the activation state of connected neural units. Each individual neural unit has a summation function which combines the values of all its inputs together. In some implementations, there is a threshold function or limiting function on at least some connections and/or on at least some neural units, such that the signal must surpass the limit before propagating to other neurons. The I-VEAS  96  can implement supervised, unsupervised, or semi-supervised machine learning. In supervised or semi-supervised machine learning the I-VEAS  96  is provided with a set of sample input data and sample output data, and adjusts the connections between the simulated neurons until it can produce the sample output data from the sample input data. Then the I-VEAS  96  is provided with a new set of input data to produce a new set of output data. In unsupervised machine learning, the I-VEAS  96  is provided only with input data, and outputs a categorization of the input data in response to patterns that it identifies in the input data. Thus, the I-VEAS  96  extracts useful information from the vascular exams procedure  205  (which blood vessel needs to be traced for each different vascular exam) and the patient information  206  (which vascular exam needs to be performed), and will complement with the human anatomy knowledge  204  (where the blood vessels are likely to be located in the patient&#39;s body). 
     For the convenience of the reader, the inventive system and method will be discussed with reference to a clinical example. The chosen clinical example is an arterial vascular exam of the lower limb. 
     The anatomy  204  of the lower limb: Blood is normally supplied to the leg through a single main artery, which has different names in different parts of the leg: common and external iliac arteries in the lower abdomen, common and superficial femoral arteries in the thigh, and popliteal artery behind the knee. Below the knee the lower limb artery branches into the smaller posterior tibial, peroneal and anterior tibial arteries. 
     The vascular exams procedures  205  of the lower limb: Patient supine on the bed. Use a curvilinear 3-5 MHz (megahertz) transducer. Put coupling gel on the thigh from groin to knee over the path of the artery. Place the scanner on the skin in the groin and identify the common femoral artery identified using the B-scan display. Switch the scanner to duplex mode, and obtain the blood velocity waveform in the common femoral artery using color Doppler scan. The peak systolic blood velocity normally lies between 90 and 140 cm/s. Values significantly above this may indicate local stenosis, while values below can indicate low flow caused by proximal or distal occlusion. Note the presence of any plaque intruding into the lumen, and estimate the degree of any stenosis. Then move the scanner along the artery until the origin of the profunda femoris artery is identified using the B-scan display. This is usually just beyond the skin crease in the groin. Obtain the blood velocity waveform at the origin, note the waveform shape and record the presence of any stenosis. Mark the position of the origin on the skin surface using a water-soluble crayon. Examine the superficial femoral artery along its length using the color Doppler display. A significant stenosis is normally taken to be one that more than doubles the blood velocity. Mark the site of any significant stenosis on the skin surface and record the distance from the vessel origin and the increase in velocity. 
     The patient information  206 : Age=44, Height=178 cm. The reason for scanning the lower limb arteries is to locate and assess any narrowing (stenosis) or blockage (occlusion). 
     Thus, in conducting the exemplary lower limb vascular exam, the I-VEAS  96  will establish based on the patient information  206  that the desired exam is of the lower limb artery. From the human anatomy knowledge  204 , the I-VEAS  96  will establish that the lower limb artery (femoral artery) follows a path through the patient&#39;s thigh, starting at the groin and ending at the knee. Additionally, from the vascular exams procedures  205  the I-VEAS  96  will establish that a first step is to place the ultrasound scanner at the patient&#39;s groin, and that subsequent steps include identifying the common femoral artery (by analyzing the structural data obtained via the traditional ultrasound), instructing an operator to switch the ultrasound scanner to duplex mode, and using Doppler ultrasound to measure the blood velocity waveform in the common femoral artery and then in the superficial femoral artery. 
     Accordingly, the I-VEAS  96  is configured to implement the method  300  for performing the lower limb vascular exam. The two main purposes of the method  300  are to find the correct vessel and to follow the correct vessel. Therefore, the I-VEAS  96  is configured to guide placement of the ultrasound scanner in an initial area to find the correct vessel, and to guide subsequent movement of the ultrasound scanner to follow the correct vessel. 
     According to an exemplary embodiment of the present invention, the method  300 , performed by the I-VEAS  96 , includes obtaining  301 , from the camera  203 , a camera image  302  of the patient on whom the exam is to be performed. Note that the camera “image” may include multiple images, e.g., a stereoscopic image. In response to the camera image  302  and based on its knowledge of the human anatomy database  204 , the I-VEAS will perform a step  303  of guiding the operator&#39;s initial placement of the ultrasound scanner at an optimal starting position on the patient&#39;s body. Guidance can be accomplished by various modes. For example, guidance of the scanner can be by a method  400  of illuminating the patient&#39;s body, using the laser  207 , at the optimal position of the scanner  214  (see  FIG.  4   ); by a method  500  of displaying an image of the supine patient (which may be the camera image, or a 3-D model of the patient), using the display  208 , with an icon  210  indicating the actual position of the scanner and another icon  211  indicating the optimal position of the scanner  214  (see  FIG.  5   ); or by a method  600  of playing an audio signal, using the speaker  209 , that varies (e.g., in frequency, volume, melody, or beat) based on the distance of the scanner  214  from its optimal position (see  FIG.  6   ). These various modes of guidance will be described below with reference to  FIGS.  4 - 6   . According to various embodiments of the invention, two or more modes of guidance may be used in combination. Other modes of guiding the scanner will be apparent to the skilled worker. 
       FIG.  4    depicts steps of the method  400  according to an exemplary embodiment of the present invention by which the I-VEAS  96  causes the laser  207  to illuminate the optimal starting position on the patient&#39;s body. Notably, when illuminating the patient&#39;s body with the laser  207 , a position and angle for shining the laser  207  can be determined responsive to the camera image  302  of the patient&#39;s body, the human anatomy database  204 , and the vascular exams procedures  205 . 
     The method  400  includes the step  301  of obtaining the camera image  302  of a patient&#39;s body  212  within a space marked by fiducials  213  and a step  402  of calculating, based on the camera image  302 , a 3-D model  404  of the patient&#39;s body  212  with reference to the fiducials  213 . The method  400  also includes a step  406  of establishing, based on a vascular exam  205  to be performed and with reference to the 3-D template of human anatomy  204 , a template starting position  408  for placing an ultrasound scanner on the 3-D template. Because the patient&#39;s body  212  will not exactly match the 3-D template  204 , which may for example be based on statistically averaged anatomy, the method  400  also includes a step  410  of mapping the template starting position  408  from the 3-D template  204  to a modeled starting position  412  on the 3-D model  404  of the patient&#39;s body. The method  400  then includes a step  414  of determining coordinates  416  of the modeled starting position with reference to the fiducials  213 , using the 3-D model  404 . The method  400  also includes using motors (not shown for clarity) to accomplish a step  418  of training the laser  207  within the fiducial-marked space to the coordinates  416  of the modeled starting position  412 . Then the I-VEAS  96  completes the step  420  of illuminating the patient&#39;s body with the laser  207  to indicate the optimal starting position for the scanner. 
       FIG.  5    depicts steps of the method  500  according to an exemplary embodiment of the present invention by which the I-VEAS  96  causes the display  208  to show a 3-D image of the supine patient, with an icon  210  indicating the actual position of the scanner and another icon  211  indicating the optimal position of the scanner. 
     The method  500  includes the step  301  of obtaining the camera image and the step  402  of calculating the 3-D model  404 . The method  500  also includes the step  406  of establishing the template starting position  408 . The method  500  also includes the step  410  of mapping the template starting position  408  from the 3-D template  204  to a modeled starting position  412  on the 3-D model  404 . The method  500  then includes the step  414  of determining coordinates  416  of the modeled starting position  412 . At this point the method  500  diverges from the method  400 , in that the method  500  also includes a step  502  of obtaining coordinates  504  of the ultrasound scanner within the space marked by the fiducials  213 . For example, in some embodiments the step  502  is accomplished by interaction of the scanner with the fiducials, e.g., wireless triangulation of the 3-D scanner coordinates with reference to the fiducials. In one or more embodiments, the step  502  is accomplished by computer image analysis of the scanner&#39;s position within the camera image  302 . The method  500  then includes a step  506  of displaying the ultrasound scanner coordinates  504  and the modeled starting position coordinates  416  at the visual display  208 , as icons  210 ,  211  superimposed on the 3-D model  404  or on the camera image  302 . 
       FIG.  6    depicts steps of the method  600  according to an exemplary embodiment of the present invention by which the I-VEAS  96  causes the speaker  209  to play an audio signal that varies according to a distance of the scanner from an optimal position. 
     The method  600  includes the step  301  of obtaining the camera image and the step  402  of calculating the 3-D model  404 . The method  600  also includes the step  406  of establishing the template starting position  408 . The method  600  also includes the step  410  of mapping the template starting position  408  from the 3-D template  204  to a modeled starting position  412  on the 3-D model  404 . The method  600  then includes the step  414  of determining coordinates  416  of the modeled starting position  412 . The method  600  also includes the step  502  of obtaining coordinates  504  of the ultrasound scanner. At this point the method  600  diverges from the methods  400  and  500 , in that the method  600  includes a step  601  of calculating a distance from the coordinates of the ultrasound scanner to the coordinates of the modeled starting position. The method  600  also includes a step  602  of determining, based on the calculated distance, at least one of a frequency, volume, melody, or beat for an audio signal; and a step  603  of playing the audio signal through the speaker  600 . 
     Referring again to  FIG.  3   , during initial placement of the ultrasound scanner, and thereafter throughout the procedure, the I-VEAS  96  will continue to obtain  301  the camera image  302  of the patient&#39;s body and will continue to obtain coordinates  504  of the ultrasound scanner. Additionally, the I-VEAS  96  will obtain  304  a traditional (“B-scan”) ultrasound image  305  of blood vessel position with reference to the ultrasound scanner as well as obtain  306  a Doppler ultrasound image  307  of blood flow in the blood vessel. The I-VEAS  96  will compare  308  the traditional ultrasound image  305  and the camera image  302  to its knowledge of human anatomy  204 , exam procedures  205 , and patient information  206  in order to determine where to move the ultrasound scanner to follow the correct blood vessel. The I-VEAS  96  then will perform a step  309  of guiding the scanner movement to a next optimal position, according to any of the several modes discussed above with reference to  FIGS.  4 - 6   . For example, the I-VEAS  96  may illuminate  700  the patient with the laser  207  to show a next scanner position; or display  800  icons of the scanner coordinates  504  and of an optimal position for the scanner, superimposed on the 3-D model  404  of the patient&#39;s body; or play  900  an audio signal, through the speaker  209 , that varies (e.g., in frequency, volume, melody, or beat) according to whether the scanner is moving in the right direction. According to various embodiments of the invention, two or more modes of guidance may be used in combination. Other modes of guiding the scanner will be apparent to the skilled worker. Thus, throughout guidance of the scanner the I-VEAS  96  confirms to the operator whether the scanner has been moved to a proper position. For example, when the scanner is optimally positioned the I-VEAS  96  plays a pleasant tone through the speaker  209 , displays a pastel hue at the display  208 , or slowly pulses the laser  207 . On the other hand, in this example, while the scanner is not optimally positioned the I-VEAS  96  plays an off-key tone through the speaker  209 , displays a garish hue at the display  208 , or rapidly blinks the laser  207 . 
     For example, with reference to  FIG.  7   , a method  700  for guiding the ultrasound scanner to a next optimal position along a vascular structure, using the laser  207 , includes the step  301  of obtaining the camera image  302  of the patient&#39;s body  212  within the space marked by fiducials  213 , then a step  402  of calculating the 3-D model  404  of the patient&#39;s body. Further, the 3-D model  404  may include the ultrasound scanner coordinates  504  that are obtained as discussed above with reference to  FIGS.  5  and  6   . According to at least one embodiment of the present invention, based on the ultrasound image  305  and the ultrasound scanner coordinates  504 , the method  700  includes a step  704  of establishing a path  706  of the vascular structure within the 3-D model  404 . Then the method  700  includes a step  708  of determining coordinates  710  of a next optimal position for the ultrasound scanner  202  based on the vascular exam procedure  205  and the vascular structure path  605 . The method  700  proceeds to the step  418  of directing the laser  207  to the coordinates  710  within the space marked by the fiducials  213 , then to the step  420  of illuminating the patient&#39;s body with the laser. 
       FIG.  8    illustrates another method  800  according to an exemplary embodiment of the present invention for guiding the ultrasound scanner to a next optimal position along a vascular structure, using the visual display  208 . The method  800  includes the step  301  of obtaining the camera image  302 , the step  402  of calculating the 3-D model  404 , the step  704  of establishing a path  706  of the vascular structure, and the step  708  of determining coordinates  710  of the next optimal position for the ultrasound scanner  202 . Then the method  800  proceeds to the step  506  of displaying the ultrasound scanner coordinates  504  and the next optimal position coordinates  710  as icons  210 ,  211  at the visual display  208 . 
       FIG.  9    depicts another method  900  according to an exemplary embodiment of the present invention for guiding the ultrasound scanner to a next optimal position along a vascular structure, using the speaker  209 . The method  900  includes the step  301  of obtaining the camera image  302 , the step  402  of calculating the 3-D model  404 , the step  704  of establishing a path  706  of the vascular structure, and the step  708  of determining coordinates  710  of the next optimal position for the ultrasound scanner  202 . Then the method  900  proceeds to the step  601  of calculating a distance between the ultrasound scanner coordinates  504  and the next optimal position coordinates  710 , the step  602  of determining an audio signal to generate in response to the calculated distance, and the step  603  of playing the audio signal through the speaker  209 . 
     Referring again to  FIG.  3   , while guiding movement of the ultrasound scanner, the I-VEAS  96  also will facilitate a step  310  of assessing the B-scan or Doppler ultrasound data for a vascular abnormality, for example, stenosis or occlusion of an artery. As mentioned above, peak systolic blood velocity normally lies between 90 and 140 cm/s. Values significantly above this may indicate local stenosis, while values below can indicate low flow caused by proximal or distal occlusion. In case the I-VEAS  96  detects any such abnormality, it will estimate the degree of stenosis or occlusion and incorporate that estimate into the patient information  206 . The I-VEAS  96  also will facilitate a step  311  of alerting the operator. The alert may be by text or image at the display  208 , by an audio signal via the speaker  209 , and/or by illuminating the patient with the laser  207  to mark the approximate location of the abnormality (for example, the I-VEAS  96  may cause the laser to blink in a pattern or color distinct from patterns or colors that indicate on-track or off-track scanner position). Such laser illumination will be helpful to the operator in making a less ephemeral marking with a water-soluble crayon or the like. 
     Given the discussion thus far, and with reference to the drawing Figures, it will be appreciated that, in general terms, an exemplary computer-implemented method  300 , according to an aspect of the invention, includes a step  406  of determining an optimal position for placement of an ultrasound scanner on a patient&#39;s body, in response to at least a camera image  302 , a database of human anatomy  204 , an exam procedure  205 , and patient information  206 . The method  300  also includes a step  303  or  309  of guiding the ultrasound scanner to the optimal position for placement. According to one or more implementations of the exemplary method  300 , the step  303  or  309  of guiding the scanner includes at least one of illuminating the patient&#39;s body  212  with a laser  207  at the optimal position, displaying at a display  208  a 3-D model or an image of the patient&#39;s body with an icon  211  marking the optimal position, and playing through a speaker  209  an audio signal that varies according to a distance of the scanner from the optimal position. Guiding the ultrasound scanner also may include displaying at the display  208  an icon  210  marking the position of the scanner. 
     In at least one exemplary embodiment, the method  300  includes a step  310  of assessing ultrasound data from the scanner for a vascular abnormality. Further, the method  300  includes estimating a degree of stenosis or occlusion; and incorporating the estimate into the patient information. Additionally, the method  300  includes a step  311  of alerting an operator to the presence of the vascular abnormality. For example, alerting can include at least one of illuminating the patient&#39;s body with a laser at an approximate location of the vascular abnormality, displaying text or an image at a display, and playing an audio signal through a speaker. 
     According to another exemplary aspect of the invention, a computer-implemented method  300  includes a step  301  of obtaining, at a processor  16  operatively coupled in communication with a camera  203 , a camera image  302  of a patient&#39;s body  212  within a space marked by fiducials  213 . The method  300  also includes a step  402  of calculating, in the processor, based on the camera image  302 , a 3-D model  404  of the patient&#39;s body with reference to the fiducials  213 . Further, the method  300  includes a step  406  of establishing, in the processor  16 , based on a vascular exam to be performed and with reference to a 3-D template of human anatomy  204 , a template starting position  408  for placing an ultrasound scanner on the 3-D template. Additionally, the method  300  includes a step  410  of mapping, in the processor, the template starting position  408  from the 3-D template  204  to a modeled starting position  412  on the 3-D model of the patient&#39;s body. Further, the method  300  includes a step  414  of determining, in the processor, coordinates  416  of the modeled starting position with reference to the fiducials  213 ; and a step  303  of guiding the ultrasound scanner to the coordinates of the modeled starting position. For example, in one or more implementations of the invention, guiding the ultrasound scanner includes a step  418  of the processor operating motors to direct a laser  207  to the coordinates of the modeled starting position, and a step  420  of illuminating the patient&#39;s body with the laser. In one or more implementations of the invention, guiding the ultrasound scanner includes a step  502  of obtaining coordinates  504  of the ultrasound scanner with reference to the fiducials  213 , and a step  506  of displaying an icon  210  for the ultrasound scanner coordinates and an icon  211  for the modeled starting position, superimposed on the 3-D model  404 , at a visual display  208  that is operatively coupled in communication with the processor  16 . For example, in some implementations, the coordinates  504  of the ultrasound scanner are determined through interaction of the ultrasound scanner with the fiducials  213 . In one or more implementations, guiding the ultrasound scanner includes the step  502  of obtaining coordinates  504  of the ultrasound scanner with reference to the fiducials  213 , a step  601  of calculating a distance from the coordinates of the ultrasound scanner to the coordinates of the modeled starting position, a step  602  of determining, based on the calculated distance, at least one of a frequency, volume, melody, or beat for an audio signal, and a step  603  of playing the audio signal through a speaker  600  operatively coupled in communication with the processor. 
     Other exemplary aspects of the invention provide a computer-implemented method  700  that includes a step  301  of obtaining a camera image  302  of a patient&#39;s body  212  within a space marked by fiducials  213 . The method  500  also includes a step  304  of obtaining an ultrasound image  305  of a vascular structure within the patient&#39;s body. The method  500  also includes a step  402  of calculating, based on the camera image  302 , a 3-D model  404  of the patient&#39;s body with reference to the fiducials  213 , including coordinates  504  of an ultrasound scanner within the 3-D model. Further, the method  500  includes a step  704  of establishing a path  706  of the vascular structure within the 3-D model, based on the ultrasound image  305  and the coordinates  504  of the ultrasound scanner within the 3-D model. Then the method  500  includes a step  708  of determining coordinates  710  of a next optimal position for the ultrasound scanner, based on the path of the vascular structure and a vascular exam procedure to be performed; and a step  309  of guiding the ultrasound scanner to the coordinates  710  of the next optimal position. 
     In certain implementations, the step  309  of guiding the ultrasound scanner includes a step  418  of training a laser  207  on the coordinates  710  of the next optimal position, and a step  420  of illuminating a patient&#39;s body with the laser. 
     In certain implementations, guiding the ultrasound scanner includes obtaining coordinates  504  of the ultrasound scanner with reference to the fiducials  213 . 
     In certain implementations, guiding the ultrasound scanner includes a step  506  of displaying an icon  210  for the ultrasound scanner coordinates  504  and an icon  211  for the modeled starting position  412  at a visual display  208  that is operatively coupled in communication with the processor  96 . For example, in some implementations the coordinates  504  of the ultrasound scanner are determined through interaction of the ultrasound scanner with the fiducials  213 . 
     In certain implementations, guiding the ultrasound scanner includes a step  601  of calculating a distance from the coordinates of the ultrasound scanner to the coordinates of the modeled starting position, as well as a step  602  of determining, based on the calculated distance, at least one of a frequency, volume, melody, or beat for an audio signal. In such implementations, guiding the ultrasound scanner also includes a step  603  of playing the audio signal through a speaker operatively coupled in communication with the processor. 
     Certain aspects of the invention provide an apparatus  200 , which includes a memory  28  storing computer executable instructions  40 ; a camera  203 ; an ultrasound scanner  214 ; and at least one processor  16 , coupled to the memory  28 . The at least one processor  16  is configured according to the computer executable instructions  40  to facilitate a method  300 . The method  300  includes a step  301  of obtaining from the camera  203  a camera image  302  of a patient&#39;s body  212  within a space marked by fiducials  213 , as well as a step  402  of calculating, based on the camera image  302 , a 3-D model  404  of the patient&#39;s body with reference to the fiducials  213 . The method  300  further includes a step  406  of establishing, based on a vascular exam to be performed  205  and with reference to a 3-D template of human anatomy  204 , a template starting position  408  for placing an ultrasound scanner on the 3-D template. The method  300  also includes a step  410  of mapping the template starting position from the 3-D template  204  to a modeled starting position  412  on the 3-D model  404  of the patient&#39;s body, and a step  414  of determining coordinates  416  of the modeled starting position  412  within the 3-D model  404  with reference to the fiducials  213 . Additionally, the method  300  includes a step  303  of guiding the ultrasound scanner to the coordinates  416  of the modeled starting position  412 . 
     According to certain embodiments of the exemplary apparatus  100 , guiding the ultrasound scanner includes the processor facilitating a step  418  of operating motors to train a laser  207  to the coordinates  416  of the modeled starting position  412 , and a step  420  of illuminating the patient&#39;s body with the laser. 
     According to one or more embodiments of the exemplary apparatus, guiding the ultrasound scanner includes the processor facilitating a step  502  of obtaining coordinates  504  of the ultrasound scanner with reference to the fiducials  213 , and displaying an icon  210  for the ultrasound scanner coordinates and an icon  211  for the modeled starting position  412  at a visual display  208  that is operatively coupled in communication with the processor  16 . 
     According to one or more embodiments of the exemplary apparatus  200 , guiding the ultrasound scanner  214  includes the processor  16  facilitating the step  502  of obtaining coordinates  504  of the ultrasound scanner with reference to the fiducials  213 , as well as a step  601  of calculating a distance from the coordinates of the ultrasound scanner to the coordinates of the modeled starting position. Additionally, according to one or more embodiments of the apparatus, the processor facilitates the step  602  of determining, based on the calculated distance, at least one of a frequency, volume, melody, or beat for an audio signal; and the step  603  of playing the audio signal through a speaker operatively coupled in communication with the processor. 
     Other embodiments of the invention provide an apparatus  200 , which includes a memory  28  storing computer executable instructions  40 ; a camera  203 ; an ultrasound scanner  214 ; and at least one processor  16 , coupled to the memory  28 , and configured according to the computer executable instructions to facilitate a method  300 . The method  300  includes a step  301  of obtaining from the camera  203  a camera image  302  of a patient&#39;s body  212  within a space marked by fiducials  214 , and includes a step  304  of obtaining from the ultrasound scanner  214  an ultrasound image  305  of a vascular structure within the patient&#39;s body. The method  300  also includes a step  402  of calculating, based on the camera image  302 , a 3-D model  404  of the patient&#39;s body with reference to the fiducials  213 , including coordinates  504  of the ultrasound scanner within the 3-D model. The method  300  also includes a step  704  of establishing a path  706  of the vascular structure within the 3-D model  404 , based on the ultrasound image  305  and the coordinates of the ultrasound scanner  504  within the 3-D model  404 . Additionally, the method  300  includes a step  708  of determining coordinates  710  within the 3-D model of a next optimal position for the ultrasound scanner, based on the path  706  and the vascular exam procedure  205  to be performed. Finally, the method  300  includes a step  309  of guiding the ultrasound scanner  214  to the coordinates  710  of the next optimal position. According to one or more embodiments, guiding the ultrasound scanner includes the processor facilitating the step  418  of operating motors to direct a laser  207  to the coordinates of the modeled starting position; and facilitating the step  420  of illuminating the patient&#39;s body with the laser  207 . According to one or more embodiments, guiding the ultrasound scanner includes the processor facilitating the step  502  of obtaining coordinates  504  of the ultrasound scanner  214  with reference to the fiducials  213 . According to one or more embodiments, guiding the ultrasound scanner includes the processor facilitating the step  506  of displaying an icon  210  for the ultrasound scanner coordinates and an icon  211  for the modeled starting position at a visual display  208  that is operatively coupled in communication with the processor  16 . According to one or more embodiments, guiding the ultrasound scanner includes the processor facilitating the step  601  of calculating a distance from the coordinates of the ultrasound scanner to the coordinates of the modeled starting position; the step  602  of determining, based on the calculated distance, at least one of a frequency, volume, melody, or beat for an audio signal; and the step  603  of playing the audio signal through a speaker operatively coupled in communication with the processor. 
     One or more embodiments of the invention, or elements thereof, can be implemented in the form of an apparatus including a memory and at least one processor that is coupled to the memory and operative to perform exemplary method steps.  FIG.  10    depicts a computer system that may be useful in implementing one or more aspects and/or elements of the invention, also representative of a cloud computing node according to an embodiment of the present invention. Referring now to  FIG.  10   , cloud computing node  10  is only one example of a suitable cloud computing node and is not intended to suggest any limitation as to the scope of use or functionality of embodiments of the invention described herein. Regardless, cloud computing node  10  is capable of being implemented and/or performing any of the functionality set forth hereinabove. 
     In cloud computing node  10  there is a computer system/server  12 , which is operational with numerous other general purpose or special purpose computing system environments or configurations. Examples of well-known computing systems, environments, and/or configurations that may be suitable for use with computer system/server  12  include, but are not limited to, personal computer systems, server computer systems, thin clients, thick clients, handheld or laptop devices, multiprocessor systems, microprocessor-based systems, set top boxes, programmable consumer electronics, network PCs, minicomputer systems, mainframe computer systems, and distributed cloud computing environments that include any of the above systems or devices, and the like. 
     Computer system/server  12  may be described in the general context of computer system executable instructions, such as program modules, being executed by a computer system. Generally, program modules may include routines, programs, objects, components, logic, data structures, and so on that perform particular tasks or implement particular abstract data types. Computer system/server  12  may be practiced in distributed cloud computing environments where tasks are performed by remote processing devices that are linked through a communications network. In a distributed cloud computing environment, program modules may be located in both local and remote computer system storage media including memory storage devices. 
     As shown in  FIG.  10   , computer system/server  12  in cloud computing node  10  is shown in the form of a general-purpose computing device. The components of computer system/server  12  may include, but are not limited to, one or more processors or processing units  16 , a system memory  28 , and a bus  18  that couples various system components including system memory  28  to processor  16 . 
     Bus  18  represents one or more of any of several types of bus structures, including a memory bus or memory controller, a peripheral bus, an accelerated graphics port, and a processor or local bus using any of a variety of bus architectures. By way of example, and not limitation, such architectures include Industry Standard Architecture (ISA) bus, Micro Channel Architecture (MCA) bus, Enhanced ISA (EISA) bus, Video Electronics Standards Association (VESA) local bus, and Peripheral Component Interconnect (PCI) bus. 
     Computer system/server  12  typically includes a variety of computer system readable media. Such media may be any available media that is accessible by computer system/server  12 , and it includes both volatile and non-volatile media, removable and non-removable media. 
     System memory  28  can include computer system readable media in the form of volatile memory, such as random access memory (RAM)  30  and/or cache memory  32 . Computer system/server  12  may further include other removable/non-removable, volatile/non-volatile computer system storage media. By way of example only, storage system  34  can be provided for reading from and writing to a non-removable, non-volatile magnetic media (not shown and typically called a “hard drive”). Although not shown, a magnetic disk drive for reading from and writing to a removable, non-volatile magnetic disk (e.g., a “floppy disk”), and an optical disk drive for reading from or writing to a removable, non-volatile optical disk such as a CD-ROM, DVD-ROM or other optical media can be provided. In such instances, each can be connected to bus  18  by one or more data media interfaces. As will be further depicted and described below, memory  28  may include at least one program product having a set (e.g., at least one) of program modules that are configured to carry out the functions of embodiments of the invention. 
     Program/utility  40 , having a set (at least one) of program modules  42 , may be stored in memory  28  by way of example, and not limitation, as well as an operating system, one or more application programs, other program modules, and program data. Each of the operating system, one or more application programs, other program modules, and program data or some combination thereof, may include an implementation of a networking environment. Program modules  42  generally carry out the functions and/or methodologies of embodiments of the invention as described herein. 
     Computer system/server  12  may also communicate with one or more external devices  14  such as a keyboard, a pointing device, a display  24 , etc.; one or more devices that enable a user to interact with computer system/server  12 ; and/or any devices (e.g., network card, modem, etc.) that enable computer system/server  12  to communicate with one or more other computing devices. Such communication can occur via Input/Output (I/O) interfaces  22 . Still yet, computer system/server  12  can communicate with one or more networks such as a local area network (LAN), a general wide area network (WAN), and/or a public network (e.g., the Internet) via network adapter  20 . As depicted, network adapter  20  communicates with the other components of computer system/server  12  via bus  18 . It should be understood that although not shown, other hardware and/or software components could be used in conjunction with computer system/server  12 . Examples, include, but are not limited to: microcode, device drivers, redundant processing units, and external disk drive arrays, RAID systems, tape drives, and data archival storage systems, etc. 
     Thus, one or more embodiments can make use of software running on a general purpose computer or workstation. With reference to  FIG.  10   , such an implementation might employ, for example, a processor  16 , a memory  28 , and an input/output interface  22  to a display  24  and external device(s)  14  such as a keyboard, a pointing device, or the like. The term “processor” as used herein is intended to include any processing device, such as, for example, one that includes a CPU (central processing unit) and/or other forms of processing circuitry. Further, the term “processor” may refer to more than one individual processor. The term “memory” is intended to include memory associated with a processor or CPU, such as, for example, RAM (random access memory)  30 , ROM (read only memory), a fixed memory device (for example, hard drive  34 ), a removable memory device (for example, diskette), a flash memory and the like. In addition, the phrase “input/output interface” as used herein, is intended to contemplate an interface to, for example, one or more mechanisms for inputting data to the processing unit (for example, mouse), and one or more mechanisms for providing results associated with the processing unit (for example, printer). The processor  16 , memory  28 , and input/output interface  22  can be interconnected, for example, via bus  18  as part of a data processing unit  12 . Suitable interconnections, for example via bus  18 , can also be provided to a network interface  20 , such as a network card, which can be provided to interface with a computer network, and to a media interface, such as a diskette or CD-ROM drive, which can be provided to interface with suitable media. 
     Accordingly, computer software including instructions or code for performing the methodologies of the invention, as described herein, may be stored in one or more of the associated memory devices (for example, ROM, fixed or removable memory) and, when ready to be utilized, loaded in part or in whole (for example, into RAM) and implemented by a CPU. Such software could include, but is not limited to, firmware, resident software, microcode, and the like. 
     A data processing system suitable for storing and/or executing program code will include at least one processor  16  coupled directly or indirectly to memory elements  28  through a system bus  18 . The memory elements can include local memory employed during actual implementation of the program code, bulk storage, and cache memories  32  which provide temporary storage of at least some program code in order to reduce the number of times code must be retrieved from bulk storage during implementation. 
     Input/output or I/O devices (including but not limited to keyboards, displays, pointing devices, and the like) can be coupled to the system either directly or through intervening I/O controllers. 
     Network adapters  20  may also be coupled to the system to enable the data processing system to become coupled to other data processing systems or remote printers or storage devices through intervening private or public networks. Modems, cable modem and Ethernet cards are just a few of the currently available types of network adapters. 
     As used herein, including the claims, a “server” includes a physical data processing system (for example, system  12  as shown in  FIG.  10   ) running a server program. It will be understood that such a physical server may or may not include a display and keyboard. 
     One or more embodiments can be at least partially implemented in the context of a cloud or virtual machine environment, although this is exemplary and non-limiting. Reference is made back to  FIGS.  1 - 2    and accompanying text. 
     It should be noted that any of the methods described herein can include an additional step of providing a system comprising distinct software modules embodied on a computer readable storage medium; the modules can include, for example, any or all of the appropriate elements depicted in the block diagrams and/or described herein; by way of example and not limitation, any one, some or all of the modules/blocks and or sub-modules/sub-blocks described. The method steps can then be carried out using the distinct software modules and/or sub-modules of the system, as described above, executing on one or more hardware processors such as  16 . Further, a computer program product can include a computer-readable storage medium with code adapted to be implemented to carry out one or more method steps described herein, including the provision of the system with the distinct software modules. 
     One example of user interface that could be employed in some cases is hypertext markup language (HTML) code served out by a server or the like, to a browser of a computing device of a user. The HTML is parsed by the browser on the user&#39;s computing device to create a graphical user interface (GUI). 
     Exemplary System and Article of Manufacture Details 
     The present invention may be a system, a method, and/or a computer program product. The computer program product may include a computer readable storage medium (or media) having computer readable program instructions thereon for causing a processor to carry out aspects of the present invention. 
     The computer readable storage medium can be a tangible device that can retain and store instructions for use by an instruction execution device. The computer readable storage medium may be, for example, but is not limited to, an electronic storage device, a magnetic storage device, an optical storage device, an electromagnetic storage device, a semiconductor storage device, or any suitable combination of the foregoing. A non-exhaustive list of more specific examples of the computer readable storage medium includes the following: a portable computer diskette, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), a static random access memory (SRAM), a portable compact disc read-only memory (CD-ROM), a digital versatile disk (DVD), a memory stick, a floppy disk, a mechanically encoded device such as punch-cards or raised structures in a groove having instructions recorded thereon, and any suitable combination of the foregoing. A computer readable storage medium, as used herein, is not to be construed as being transitory signals per se, such as radio waves or other freely propagating electromagnetic waves, electromagnetic waves propagating through a waveguide or other transmission media (e.g., light pulses passing through a fiber-optic cable), or electrical signals transmitted through a wire. 
     Computer readable program instructions described herein can be downloaded to respective computing/processing devices from a computer readable storage medium or to an external computer or external storage device via a network, for example, the Internet, a local area network, a wide area network and/or a wireless network. The network may comprise copper transmission cables, optical transmission fibers, wireless transmission, routers, firewalls, switches, gateway computers and/or edge servers. A network adapter card or network interface in each computing/processing device receives computer readable program instructions from the network and forwards the computer readable program instructions for storage in a computer readable storage medium within the respective computing/processing device. 
     Computer readable program instructions for carrying out operations of the present invention may be assembler instructions, instruction-set-architecture (ISA) instructions, machine instructions, machine dependent instructions, microcode, firmware instructions, state-setting data, configuration data for integrated circuitry, or either source code or object code written in any combination of one or more programming languages, including an object oriented programming language such as Smalltalk, C++, or the like, and procedural programming languages, such as the “C” programming language or similar programming languages. The computer readable program instructions may execute entirely on the user&#39;s computer, partly on the user&#39;s computer, as a stand-alone software package, partly on the user&#39;s computer and partly on a remote computer or entirely on the remote computer or server. In the latter scenario, the remote computer may be connected to the user&#39;s computer through any type of network, including a local area network (LAN) or a wide area network (WAN), or the connection may be made to an external computer (for example, through the Internet using an Internet Service Provider). In some embodiments, electronic circuitry including, for example, programmable logic circuitry, field-programmable gate arrays (FPGA), or programmable logic arrays (PLA) may execute the computer readable program instructions by utilizing state information of the computer readable program instructions to personalize the electronic circuitry, in order to perform aspects of the present invention. 
     Aspects of the present invention are described herein with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems), and computer program products according to embodiments of the invention. It will be understood that each block of the flowchart illustrations and/or block diagrams, and combinations of blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer readable program instructions. 
     These computer readable program instructions may be provided to a processor of a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions/acts specified in the flowchart and/or block diagram block or blocks. These computer readable program instructions may also be stored in a computer readable storage medium that can direct a computer, a programmable data processing apparatus, and/or other devices to function in a particular manner, such that the computer readable storage medium having instructions stored therein comprises an article of manufacture including instructions which implement aspects of the function/act specified in the flowchart and/or block diagram block or blocks. 
     The computer readable program instructions may also be loaded onto a computer, other programmable data processing apparatus, or other device to cause a series of operational steps to be performed on the computer, other programmable apparatus or other device to produce a computer implemented process, such that the instructions which execute on the computer, other programmable apparatus, or other device implement the functions/acts specified in the flowchart and/or block diagram block or blocks. 
     The flowchart and block diagrams in the Figures illustrate the architecture, functionality, and operation of possible implementations of systems, methods, and computer program products according to various embodiments of the present invention. In this regard, each block in the flowchart or block diagrams may represent a module, segment, or portion of instructions, which comprises one or more executable instructions for implementing the specified logical function(s). In some alternative implementations, the functions noted in the blocks may occur out of the order noted in the Figures. For example, two blocks shown in succession may, in fact, be executed substantially concurrently, or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved. It will also be noted that each block of the block diagrams and/or flowchart illustration, and combinations of blocks in the block diagrams and/or flowchart illustration, can be implemented by special purpose hardware-based systems that perform the specified functions or acts or carry out combinations of special purpose hardware and computer instructions. 
     The descriptions of the various embodiments of the present invention have been presented for purposes of illustration, but are not intended to be exhaustive or limited to the embodiments disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the described embodiments. The terminology used herein was chosen to best explain the principles of the embodiments, the practical application or technical improvement over technologies found in the marketplace, or to enable others of ordinary skill in the art to understand the embodiments disclosed herein.