(19)
(11)EP 2 186 483 B1

(12)EUROPEAN PATENT SPECIFICATION

(45)Mention of the grant of the patent:
24.06.2020 Bulletin 2020/26

(21)Application number: 09015067.3

(22)Date of filing:  01.07.2003
(51)Int. Cl.: 
A61B 8/08  (2006.01)

(54)

Instantaneous ultrasonic measurement of the volume of fluid in a body cavity

Unmittelbare Ultraschallmessung des Flüssigkeitsvolumens in einer Körperhöhle

Mesure ultrasonique instantanée du volume d'un fluid dans la cavité du corps


(84)Designated Contracting States:
AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IT LI LU MC NL PT RO SE SI SK TR

(30)Priority: 09.08.2002 GB 0218547

(43)Date of publication of application:
19.05.2010 Bulletin 2010/20

(62)Application number of the earlier application in accordance with Art. 76 EPC:
03792210.1 / 1551305

(73)Proprietor: Verathon Medical (Europe) B.V.
3401 MS IJsselstein (NL)

(72)Inventors:
  • McMorrow, Gerald, James
    Duvall Washington 98019 (US)
  • Baartmans, Henri
    3401 HT Ijsselstein (NL)
  • Bom, Nicolaas
    2825 NA Berkenwoulde (NL)
  • Lancee, Charles, Theodor
    9423 PH Hoogensmilde (NL)

(74)Representative: Potter Clarkson 
The Belgrave Centre Talbot Street
Nottingham NG1 5GG
Nottingham NG1 5GG (GB)


(56)References cited: : 
WO-A1-00/04831
US-A- 5 058 591
US-A- 5 928 151
US-A- 6 110 111
US-B1- 6 406 431
WO-A1-00/30541
US-A- 5 235 985
US-A- 5 964 710
US-B1- 6 213 949
  
      
    Note: Within nine months from the publication of the mention of the grant of the European patent, any person may give notice to the European Patent Office of opposition to the European patent granted. Notice of opposition shall be filed in a written reasoned statement. It shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention).


    Description


    [0001] The present invention relates to methods and apparatus for the measurement of volume of a fluid filled cavity in a human or animal body, such as a bladder, using ultrasound techniques.

    TECHNICAL FIELD



    [0002] This disclosure concerns an apparatus which, in a first version, with a limited number of fixed ultrasound transducers with narrow sound beams oriented in well defined directions, automatically determines the volume of the human bladder without assumption of any geometrical bladder shape, where volume is calculated by (Height x Depth x K) and the empirically measured K factor varies with bladder filling degree, which in turn is indicated by the number of ultrasonic beams that intercept the filled bladder. In this first version, standard echographic technique is used where short ultrasound pulses are transmitted at fundamental frequency and the echo travel time is used to calculate distance.

    [0003] In a second version, with a wide ultrasound beam, pulses are transmitted at fundamental frequency. Due to the wide sound beam this beam encompasses a large part of the volume of a possibly filled bladder. Echo signals from a large distance W, where W is the average distance from the transducer in dorsal direction to a point beyond the posterior wall of an average filled bladder, are analyzed for higher harmonic contents. Non-linear behavior will increase with depth and particularly be stimulated by presence of urine. Attenuation of returned echo signals from a large distance will be considerably less in the presence of urine. A combination of these two effects will favor presence of higher harmonics as compared to the presence of the fundamental frequency in the return signal. With this information urine quantity or a critical urine filling level of the bladder can be established.

    [0004] In a third version a combination of a narrow ultrasound beam for detection of the posterior bladder wall distance W with the wide acoustic beam approach for subsequent measurement of urine filling of the bladder is described.

    BACKGROUND OF THE INVENTION



    [0005] It is well known that bladder dysfunction is associated with a number of clinical conditions requiring treatment. In many of these cases it is important to accurately determine the volume of the bladder. Under other conditions such as post-operative recovery, where there is temporary loss of bladder sensation and/or loss of the normal voiding mechanism too much distention of the bladder has to be avoided. Under those conditions voiding by catheter introduction is carried out. However, serious disadvantages to unnecessary catheterization range from. the uncomfortable situation for the patient to serious possibilities of infection. Thus, a non-invasive quick measurement of bladder volume, with the patient usually in the supine position, is indicated. Sometimes the accurate determination of volume is indicated; sometimes however an indication is sufficient. Questions that may be asked are for instance: after voiding: "is there still too much urine left?"; or after surgery "is the bladder filling above a certain level so that voiding is necessary?"

    [0006] Non-invasive procedures for bladder volume estimation are known, but are either unreliable or expensive or have some other significant disadvantages.

    [0007] Palpation and auscultatory percussion are known to be unreliable, while radiography and dye-excretion techniques are known to be similarly inaccurate. For assessing bladder volume, catheterization remains the "gold standard". However, it is invasive, painful and might produce traumas or infections.

    SUBJECT



    [0008] The described technique concerns measurement of urine volume in the human bladder with the use of pulsed ultrasound with a limited number of ultrasound transducers.

    [0009] In a first version a limited number of transducers are mounted in a transducer assembly. The assembly is positioned non-invasively at the body skin over the position of the bladder with the patient in a supine position. For acoustic contact a coupling gel may be used. Each ultrasound transducer in the assembly transmits and receives the ultrasound signal in a narrow beam through the contact plane. During the measurement the transducers are used in a certain succession. All transducers have been mounted in the assembly such that in transmission and reception successively the beams penetrate the area of the bladder in approximately the sagittal cross sectional plane. The sagittal plane is here defined as antero-posterior plane of the body. One transducer beam direction is dorsal with in addition at least one transducer beam in the dorsal-caudal and one transducer beam in the dorsal-cranial direction. The volume is calculated on the basis of two bladder measurements defined in the sagittal plane as Depth (D) and Height (H). These measurements are derived on the basis of echo travel time from echoes originating at the anterior and posterior bladder wall. Depth is in principle a measurement in dorsal direction. Height is a measurement approximately in the cranial direction. The volume is calculated depending on the specific, filling dependent, measurement configuration following the formula D × H × K. Where K is an empirically measured, filling configuration dependant, correction factor. Beam directions and examples for D and H are illustrated in figures 1 and 2.

    [0010] In a second version of the described technique a single wide beam ultrasound transducer is positioned non-invasively at the body skin over the location of the bladder. The wide beam can be created by the curved surface of the transducer or by a flat acoustically active surface of for instance a disk shaped transducer supplied with a curved lens. Ultrasonic signals are transmitted and received in the wide, cone like, ultrasound beam and propagation is approximately spherical. Similar to the above described method a pulsed echo signal is transmitted at fundamental ultrasonic frequency. In this second version of the described technique echo data are analyzed as originating from a distance beyond the average position of the posterior (filled) bladder wall. The received echo signal will contain information over almost the entire bladder as encompassed by the wide ultrasound beam. Due to non-linearity, higher harmonic components will build up during propagation and thus be reflected in the returning echo. Compared to propagation through normal tissue, the presence of higher harmonics in the signal is greatly stimulated when propagating through urine. Analyses of presence of higher harmonic components in relation to the fundamental frequency is used for indication of presence of urine in the bladder. Neutralizing patient variation as to obesity etc can also be accomplished by comparing echo signals received from sequentially transmitted pulses at low transmit power (linear propagation only) and pulse transmission at high power (enhancing non-linearity).

    STATE OF THE ART



    [0011] Non-invasive bladder volume measurement techniques with ultrasound echography have been described in the art. In principle, echography measures distance based on echo travel time. Early echo techniques did use a single ultrasound transducer and echo presentation was recorded as echo amplitude versus depth. West, K A: "Sonocystography: A method for measuring residual urine", Scand J Urol Nephrol 1: pp68 - 70, 1967 describes the subsequent use of some discrete beam directions. He does not have a separate transducer for each beam direction. His method is only qualitative, not instantaneous, and based on distance measurement to the dorsal posterior bladder wall. His method is not adjusted to specific, filling dependent, measuring configurations. A relation between the difference in echo travel time between echoes from the posterior an anterior bladder wall and the independently measured bladder volume has been reported by Holmes, J H: "Ultrasonic studies of the bladder", J Urology, Vol 97, pp.654 - 663. His described volume measurement method is exclusively based on bladder depth measurement. Since the bladder changes in shape when filling, a single distance measurement is not precise enough to predict the entire bladder volume. No filling dependent measurement configuration is used.

    [0012] Diagnostic ultrasound is today well known for real-time cross-sectional imaging of human organs. For cross-sectional imaging the sound beam has to be swept electronically or mechanically through the cross section to be imaged. Echoes are presented as intensity modulated dot on the display. The instruments are costly and require a skilled operator. Volume is sometimes calculated based on bladder contours obtained in two orthogonal planes with a geometric assumption of bladder shape. For 3-dimensional or volumetric echography the sound beam has to be swept through the entire organ. This further increases complexity, acquisition time of the data, and costs of the instrument.

    [0013] Hakenberg et al: "The Estimation of Bladder Volume by Sonocystography", J Urol, Vol 130, pp249 - 251, have reported a simple method that is based on measuring the diameters obtained in a cross sectional image in the midline sagittal bladder plane only. The bladder volume has been related to bladder Height and Depth as follows: Volume is Height x Depth x 6.6 ml. This formula showed a good correlation coefficient (r = 0.942) with a relatively large average error of 30.1%. For this approach a two-dimensional imaging apparatus was required. The used apparatus is complex and is different from the method described in this application. It does not use a single wide beam transducer or a limited number of fixed transducers in an assembly or a combination of this.

    [0014] An ultrasound apparatus for determining the bladder volume is shown in U.S. Pat. No. 4,926,871 in the name of Dipankar Ganguly et al. In this text, a number of possibilities are mentioned, amongst which a scan head embodiment referred to as a sparse linear array with transducers mounted at predetermined angles with sound beams pointing towards the same position. The volume is calculated according to a geometric model. In the claims an apparatus is described, involving an automatic calculation of bladder volume from ultrasound measurements in a first and second plane, which are substantially orthogonal to each other. Sound beams are deflected by a stepper motor. It requires a skilled operator to manipulate the scan head in a particular way to obtain the ultrasound measurements. For the volume calculation method described in this application no use is made of any geometrical model of the bladder, whereas only a limited number of sound beams approximately in the sagittal plane, or a single wide beam is used.

    [0015] Volume measurement based on echographic sampling of the bladder with a hand guided transducer mounted in a panthograph has been described by Kruczkowski et al: "A non-invasive ultrasonic system to determine residual bladder volume", IEEE Eng in Medicine & Biology Soc 10th Ann Conf, ppl623 - 1624. The sampling covers the entire bladder, follows a given pattern and is not limited to a single or two cross sections of the bladder. For the calculation he needs data from many beam directions. The acquisition procedure is time consuming and thus no instantaneous volume measurement results. The method described in this application is based on use of a single, wide beam or the use of a limited number of mutually fixed sound beams directions with instantaneous volume indication.

    [0016] The hand steered transducer guiding for recording of echo data from the bladder has subsequently gained in acquisition speed by introduction of constructions whereby the transducer, and thus the beam, was mechanically swept. This nevertheless still requires an acquisition time equivalent to full acquisition procedure and thus does not yield an instantaneous display of volume. No instantaneous feedback on optimal positioning is thus available. An example of such methods is the Bladderscan. In the Bladderscan Technology (registered trademark of Diagnostic Ultrasound Corporation) bladder volume is measured by interrogating a three-dimensional region containing the bladder and then performing image detection on the ultrasound signals returned from the region insonated. The three dimensional scan is achieved by performing twelve planar scans rotated by mechanically sweeping a transducer through a 97 degree arc in steps of 1.9 degrees. The three dimensional scanning requirement makes this instrument complex. It can not be compared with the simple approach described in this application.

    [0017] Yet another ultrasound method "System for estimating bladder volume" is described by Ganguly et al in patent 5,964,710 dated October 12, 1999. This method is based on bladder wall contour detection with echographically obtained data in a plurality of planes which subdivide the bladder. In each single plane of the plurality of planes a number of N transducers are positioned on a line to produce N ultrasound beams to measure at N positions the distance from front to back wall in the selected plan. From this the surface is derived. This procedure is repeated in the other planes as well. The volume is calculated from the weighted sum of the plurality of planes. In Ganguly's method the entire border of the bladder is echographically sampled in 3 dimensions. His method differs strongly from the method described in this application whereby only a single wide beam is used or a limited number of mutually fixed sound directions are used in approximately a sagittal plane with a filling dependent measurement configuration.

    [0018] US 6,359,190 describes a device for measuring the volume of a body cavity, such as a bladder or rectum, using ultrasound. The device is strapped to the body or incorporated into a garment such as a nappy or trainer pant. The device includes several transducers each aimed at a different region of the subject's bladder (a) to ensure that at least one ultrasound beam crosses the bladder despite variations in the way that the device has been positioned on the body, and (b) to enable the transducer with the strongest signal output to be used. An alarm signal may be output when the bladder reaches a predetermined threshold volume.

    [0019] An important parameter for assessing bladder volume if this volume has to be derived from a limited number of beams or planes is the knowledge of bladder shape and position which can drastically vary with age, gender, filling degree and disease. In the adult patient the empty bladder has the shape of a triangular prism and is located behind the pubis. When it is progressively filled, there is first a distention of the bladder depth followed by an expansion of the bladder height. The bladder shape is complex and can not be represented by a single geometrical formula such as ellipsoid, sphere etc. This explains the large error that several studies obtained when a single geometric model was used. However there exists a correlation between the bladder height and the bladder widening with progressive filling.

    [0020] In the first approach of the present disclosure an instrument is described which allows assessment of bladder volume by using only a few ultrasound beams appropriately oriented in approximately the sagittal plane. The narrow sound beams in principle diverge relative to each other. This allows covering a wide range of filling degrees of the bladder, from almost empty, when the bladder is located behind the pubis, to a full bladder that causes a substantial bladder height (See figure 1 and 2). From each beam can be established, by detection of the posterior bladder wall echo, if this beam does pass a filled bladder. From the knowledge of all beams that do pass the filled bladder the appropriate filling or measurement configuration follows. The acoustic beams are positioned in such a way that the Depth D and Height H of the bladder can be estimated for the specific measurement configuration. The volume of urine is then computed from an empirical formula D × H × K that does not depend on any geometric model. K is a known, empirically established correction factor which is specific for each measurement configuration and has been established by calibrated bladder measurements on a prior series of patients. The accuracy of the first approach is thus based on an a prior known correction factor which is related to a specific filling degree, which in turn depends on the number of beams that intercept the filled bladder.

    [0021] A second version of the instrument is based on the measurement of the presence of higher harmonics in the echo signal. For this approach the echo signal from a depth greater than the distance from the transducer to the posterior bladder wall must be analyzed. For a filled bladder in adults in a supine position, this depth W would be approximately 12 cm.

    [0022] It is known that when sound pulses are transmitted at a fundamental frequency, higher harmonics of this fundamental frequency may be present in the received echographic signal. Non-linear distortion increases with distance, insonifying ultrasound energy and frequency. Attenuation diminishes the ultrasound amplitude with increasing propagation distance and reduces the higher harmonic energy. Since attenuation of the ultrasound signal in urine is low compared to tissue and non-linear distortion in urine is large compared to tissue it results that urine is very different from tissue in its ability to generate higher harmonics. We have measured the presence of higher harmonics in the echo signal from 12 cm depth when the bladder was filled. With an empty bladder the echoes obtained from the same depth did not contain higher harmonics.

    [0023] The interest of higher harmonic signals in the ultrasound technique stems from echo contrast technology. Echo contrast material contains coated gas containing micro bubbles suspended in a fluid. These bubbles can create higher harmonic components in the echo signal due to non-linearity. This is used to indicate presence of contrast on the diagnostic image. A wide variety of pulse techniques is used to stimulate echographic visibility of contrast. These include multi pulse procedures, multi frequency procedures, power Doppler imaging, pulse coding, pulse inversion and other imaging methods. A survey is documented in "Ultrasound Contrast Agents" ISBN 1-85317-858-4 chapter 3 "Contrast-specific imaging methods" by de Jong et al. With a single transducer with wide sound beam, such as results with a curved acoustic element or a flat, disk shaped transducer plus curved lens, the propagating sound beam would encompass the entire bladder. The transducer must be designed to optimally transmit the fundamental ultrasound frequency and at the same time be capable to receive fundamental and higher harmonic echo signals. Broadband piezo-electric ceramic transducers have been described as well as combination transducers using ceramic in transmission and PVDF material in reception. In transmission a single or multi pulse procedure can be followed. If the returned echo signal with such a method would, in relation to the fundamental echo signal, be analyzed for the presence of higher harmonics, the presence of a certain level of bladder filling or the volume of urine can be established.

    [0024] EP 0271214 describes an ultrasonic device for monitoring the volume of fluid in the human bladder by using reflected ultrasound signals to determine not only the position of the bladder back wall but also energy returned from the bladder back wall. EP '214 proposes that after bladder filling to approximately 60% capacity, the distance between the back wall and the front wall of the bladder stops increasing. However, additional reverberation in the back wall provides an increase in energy in the reflected signal which can be used to determine further increases in bladder volume. US 6213949 describes a system for estimating the volume of fluid in a bladder which sequentially scans the bladder with ultrasonic beams to section the bladder into a number of transverse planes. The system determines a plurality of points on the front and back walls of the bladder, fits curves, calculates cross-sections and determines volume of the bladder.

    DESCRIPTION OF THE DRAWINGS



    [0025] 

    FIG. 1 Illustrates a sagittal (anteroposterior) cross sectional plane of a patient in supine position where a transducer assembly 1 with transducers A, B, C, D and E, is positioned on the abdominal wall just above the Symphysis Pubis 2 and the ultrasound beams are indicated to cross the area of the partially filled bladder 3. From the transducer assembly, the sound beam A intercepts the bladder area in dorso-caudal direction, soundbeam B intercepts the bladder in dorsal direction and sound beams C, D, and E respectively in dorso-cranial direction. In figure 1 the patient's leg is indicated by 4.

    FIG. 2 Illustrates various bladder filling stages from an almost empty bladder to a strongly filled bladder and the corresponding measurement configurations. Depth D and Height H have been defined for each filling situation as indicated and are calculated from detected bladder wall echoes taking the specific measurement configuration into account. For each measurement configuration a specific Depth D and Height H is defined.

    FIG 3. Illustrates, by way of example for a transducer assembly with five transducers (here only A and D, necessary for calculation of H are shown), the calculation of Height H (5) in the measurement configuration when bladder posterior wall echoes are detected originating from sound beam A, B, C and D. This is the "filled bladder" measurement configuration shown in figure 2. Apparently no posterior wall echoes are detected in sound beam E because the bladder filling is not yet in a strongly filled stage and thus beam E does not intercept the bladder. Depth D is derived from beam B (not shown in figure 3).

    FIG. 4 Represents a flow chart of the actions of the principal hardware components. In this block diagram a "useful" transducer signal occurs when bladder wall echoes are detectable in its sound beam.

    FIG 5. Illustrates a top view of five disk shaped transducers in a possible transducer assembly. The distance between transducers B, D and C, A, E and their positioning is such that all sound beams can be assumed to be in approximately a sagittal cross section through the bladder. Yet another transducer assembly with 4 transducers in a row is also illustrated.

    FIG 6. Illustrates a cross sectional view showing in the length direction a possible transducer and related sound beam orientation when five single transducers are used.

    FIG. 7 Illustrates the sagittal cross sectional plane with a single wide beam transducer non-invasively positioned on the abdominal skin surface over the filled bladder 3. Echo signal is received from a range at depth W.

    FIG 8. Is a flow chart illustrating the principal steps taken by the bladder volume measurement instrument based on a single ultrasound wide beam where detection of presence of higher harmonics in the received signal from a give depth range is used to measure volume. Two different transmit levels are used to enhance the bladder effect and eliminate patient variation.

    FIG 9. Illustrates the measured received scattered power in the fundamental frequency f0 and the higher harmonic frequencies 2f0 and 3f0 in a situation with an empty versus a filled bladder.

    FIG. 10 shows two possible transmit pulse sequences to enhance the difference between linear and non-linear sound propagation.

    FIG. 11 Illustrates a possible look-up table based on prior calibrated patient bladder volume measurements relating presence of harmonic power in the received echo signal versus volume.


    A) DETAILED DESCRIPTION OF THE FIRST METHOD.



    [0026] The first method describes a simple device that allows the assessment of bladder 23 volume, using only a few beams appropriately oriented. Under the assumption that there exists a correlation between the bladder height and width, a simple approach has been developed. It consists of a limited number of acoustic beams positioned in such a way that the depth D and the height H of the bladder could be estimated in approximately a single sagittal plane. The volume of urine is then computed from an empirical formula that does not assume any geometric model.

    [0027] In operation of the apparatus of the present invention, the transducer assembly 1 is placed on the abdomen of the patient in the supine position, just above the symphysis pubis 2. We are presenting a particular configuration of the assembly 1. Nevertheless, various configurations can be derived from this model and several modifications could be achieved (number of transducers, position, orientation, etc...) without departing from the initial ideas. The device proposed as an example is composed of five disc shaped transducers A, B, C, D and E (focused or non-focused) positioned in the assembly at predetermined distance from each other (Figure 5, top panel) and oriented at predetermined angles θA, θB, θC, θD and θE (Figure 6). Referring to Figure 5 (top panel), it appears that the transducers A, B, C, D and E are oriented in two different planes. The distance between these two planes is small compared to the bladder 3 size and thus we can assume that the information received from each transducer represent the characteristics of approximately a single sagittal or anteroposterior plane. The orientation of each beam has been determined from the knowledge of the bladder 3 position and shape when it is filling up as measured in a patient series. The first beam of the transducer assembly 1 (soundbeam from transducer A) is oriented in such a way that it reaches the bottom of the bladder, passing just above the symphysis pubis 2. The remaining beams are positioned for successively intercepting the bladder 3 when it expands with increasing filling degree.

    [0028] Computation of the Depth D and Height 5: Depending on the number of beams that are intercepting the bladder 3 and on the geometrical configuration of the transducer assembly (1), the distances H and D are determined by different mathematical procedures. For most measurement configurations the depth D of the bladder is determined by the distance between echoes derived from front and back wall of the bladder estimated from Transducer B.

    [0029] The Height H (5) calculation in the specific measurement configuration (here we selected as an example the "filled bladder" configuration of figure 2) when posterior bladder wall echoes are detected in signals obtained in beam A, B, C, and D, but not in beam E is illustrated in figure 3. For the other filling geometries the height is calculated in a corresponding way. The mathematical procedure is as follows:















    [0030] Volume computation: The volume of urine is correlated to the bladder diameter (Height 27 and Depth 26) by the empirical formulae:

    where K is a correction factor. Depending on the number of beams that allow the determination of the bladder dimensions (from 1 to 5) and others parameters such as the age, the gender, the correction factor is different. For a given situation (parameters other than number of beam are fixed), the correction factors K1, K2, K3, K4 and K5 are optimized using linear regression analysis.

    [0031] The process executed by the hardware is illustrated in the flow chart of figure 4.

    [0032] After positioning the transducer assembly correctly over the bladder area the measurement procedure is started by pressing the start button which during the (short) measurement procedure remains depressed. Subsequently the transducers are activated for transmission of ultrasound pulses and reception of echoes and possible detection of bladder wall echoes in a specific order. Thereafter it is established, when a clear posterior bladder wall echo is detected, which ultrasound beams, this we call here the beams of "useful" transducers, penetrate the filled bladder. From this, the filling situation or measurement geometry is established. As a result the proper correction factor can be selected. After calculation of the volume the value is stored in memory and displayed. During the measurement procedure the transducer assembly is slightly moved and memory data are refreshed if a larger volume is measured. The highest value will correspond with the correct bladder volume. This is displayed.

    [0033] In a general aspect, therefore, the apparatus may use beam information comprising at least: angle of incidence (known from the transducer mounting . angle), spatial position (known from the transducer position in the array) and echo travel time (deduced from the reflected beam). Other beam parameters or information from reflected beams may also be used in accordance with known ultrasound techniques, such as frequency, pulse rate etc.

    [0034] For determining body cavity and height, the apparatus may select only beams corresponding to those that have intercepted the fluid filled body cavity.

    [0035] The arrangements described in connection with figures 1 to 6 illustrate use of five transducers. This configuration was selected in order to achieve a selected degree of accuracy of measurement over a complete expected range of total volumes in a human adult. In the preferred configuration, accuracy of measurement of the order of ± 100 ml over a range encompassing a bladder fill level from 0 to approximately 800 ml has been exhibited. It will be understood that a smaller number of transducers could be used when either the desired measurement accuracy can be reduced, or when the total fill range covered can be reduced.

    [0036] For example, using just three transducers, it has been shown to be possible to cover a fill range of 0 to approximately 500 ml with an accuracy of ± 100 ml. Similarly, four transducers has been shown to cover a range 0 to approximately 700 ml, and two transducers, a range of 0 to approximately 300 ml.

    [0037] Such configurations can be used when it is only necessary to indicate gross ranges of bladder filling, or to indicate a clinically important threshold fill level.

    [0038] In other embodiments, the apparatus may be provided with an input device such as a keypad or computer interface so that the user can enter patient information, such as gender, weight and age. This information can then be used to ensure correct selection of an available correction factor, K, from a memory of the apparatus.

    [0039] The apparatus may also be provided with means for inputting calibration data, such as absolute measurements of bladder fill level separately deduced from conventional measurements. These can be stored by the apparatus and used to optimise stored K values as part of an iterative, 'self-learning' process. In other words, the apparatus may incorporate an algorithm for automatically adjusting predetermined correction factors stored therein based on calibration data entered into the machine for comparison with measurement data taken by the apparatus.

    [0040] The apparatus may also comprise a means for indicating correct caudal-cranial positioning of the transducer array on the body over the bladder. For example, in a normal measurement as suggested in figure1, it is expected that at least transducers A, B and C will indicate a bladder present condition, whereas transducers D and E might, or might not indicate bladder present, according to the bladder fill level. In the event that, for example, no signal is indicated by A, or by A and B, but signal is indicated by D or D and E, then it can be deduced that the transducer assembly is positioned too far in the cranial direction. This could be indicated on the display of the device.

    [0041] In summary, the described first method differs greatly from known other apparatus:
    1. 1) The device is composed of a limited number of static single element transducers;
    2. 2) The arrangement of the transducer is not similar to the arrangement of a linear array;
    3. 3) The transducers are oriented towards the bladder with specific angles allowing the estimation of the urine volume over a wide range of volumes;
    4. 4) The method for automatic volume computation does not assume any geometrical model for the bladder shape;
    5. 5) It is valid for any bladder shape since the volume is computed with an empirical formula for various filling ranges;
    6. 6) It is not based only on the measurement of distances between the front and back wall or area in different planes;
    7. 7) It uses an automatic detection of the bladder height and depth depending on the number of beams that intercept the bladder;
    8. 8) It optimizes the correction factor depending on the degree of filling (or other factors, such as age, gender, weight, that may influence the calculations);
    9. 9) The device includes a closed loop to easily find the optimal position;
    10. 10) The optimal position corresponds to the largest volume computed;
    11. 11) The device works instantaneously.

    B) DETAILED DESCRIPTION OF THE SECOND METHOD.



    [0042] The second version of the device is based on a different principle. The approach consists of using a single acoustic beam with a very wide width such that it encloses approximately the entire volume of the bladder when it is filled up. Such a wide beam width can be obtained using a single element transducer with a defocusing lens as drawn in figure 7 or a curved single element transducer.

    [0043] The schematic principle of transducer positioning is illustrated in figure 7. The sagittal cross section through the bladder is shown. The cone like shape of the acoustic beam allows to encompass approximately the full bladder volume, and therefore any harmonic distortion detected in the echo signal returning from a region beyond the posterior wall of the bladder around depth W, would correlate to the amount of fluid contained in the bladder.

    [0044] It has been demonstrated that the propagation of ultrasound waves is a nonlinear process. The nonlinear effects, which increase with higher intensities, have been predicted and demonstrated at frequencies and intensities used in the diagnostic range either in water or in human body (A Baker et al: "Distortion and high-frequency generation due to non-linear propagation of short ultrasonic pulses from a plane circular piston", J Acoustic Soc Am 92(3), pp1699 - 1705). The distortion is due to slight nonlinearities in sound propagation that gradually deform the shape of the propagating sound wave, and result in development of harmonic frequencies which were not present in the transmitted wave close to the transducer. This manifests itself in the frequency domain as the appearance of additional harmonic signals at integer multiples of the original frequency.

    [0045] These effects occur most strongly when ultrasound waves propagate within liquids with relatively low acoustic attenuation such as water, amniotic fluid or urine. Indeed, acoustic propagation in fluids gives rise to extreme nonlinear effects at diagnostic frequencies. Within soft tissues, nonlinear processes also take place but are modified as a result of the different acoustic characteristics of these tissues, most notably their high acoustic absorption. Indeed, water and amniotic fluids (urine) are significantly different from tissue.

    [0046] It is known from literature (A C Baker: "Prediction of non-linear propagation in water due to diagnostic medical ultrasound equipment", Phys Med Biol 1991 Vol 36, No 11, pp1457 - 1464; T Szabo et al: "Effects of non-linearity on the estimation of in-situ values of acoustic output parameters", J Ultrasound Med 18:33 - 41, 1999; M Hamilton et al: "Nonlinear acoustics", Academic Press) that the non-linearity of a medium is characterized by the coefficient of non-linearity β. Typical values for β are 3.6 for water, 4 for blood and 6.5 for fatty tissue.

    [0047] In addition to being nonlinear, all the media have acoustical loss due to absorption. The acoustical loss is described by the power law: α=α0fb where α0 is constant and b ranges from 1 to 2 depending on the medium. For water, the rate of absorption of an ultrasound wave propagating through it is quadratically related to the frequency (b=2). However, the rate of energy loss due to absorption is considered small and most of the time the dissipation-less theory is applicable over short ranges. However, biological media have large rates of energy loss and the frequency dependence has an exponential value of 1 to 1.5.

    [0048] By considering both attenuation due to absorption loss and non-linearity, the exchange of energy between the two processes is complicated, because attenuation diminishes the amplitude of the generated harmonic components with propagation distance while non-linearity builds up these harmonics. So, harmonic distortion generally tends to enrich the higher harmonic components at the expense of the lower ones (energy transfer), while absorption damps out the higher components more rapidly than the lower ones. It is therefore difficult to reach a balance in which a given component loses as much energy by absorption as it gains from nonlinear distortion. Moreover, since the conditions for stability depend on the amplitude of the wave, which slowly decreases with propagation distance, the wave can never be completely stable, only relatively so.

    [0049] The balance between the nonlinear process and the attenuation process is given by the Gol'dberg number Γ (Szabo et al), which represents a measure of which process dominates. When Γ=1, nonlinear effects are comparable to attenuation effects. If Γ is higher than 1, nonlinear processes dominate and when the Gol'dberg number is below 1, attenuation effects take over. As indication, for acoustic pressures of 500 kPa and IMPa, at a transmit frequency of 3 MHz, the Gol'dberg number is respectively 86.5 and 43.2 for water. It is only 2.8 and 1.4 for liver-like tissue respectively at these pressures. For both settings, the parameter shows that for water, non-linearity is up to thirty times greater than for tissue.

    [0050] The approach used here is based on the "non-linearity / attenuation" characteristic in differentiating between fluid media and soft tissue media. As described above, a single element transducer is placed in front of the bladder. The transducer generates a wide acoustic beam that is able to enclose the full bladder volume. Depending on the volume of urine contained in the bladder (bladder filling) and thus crossed by the acoustic beam, the amount of harmonic distortion generated in the back of the bladder will change. A radio frequency (RF) backscattered signal might be selected from a region of interest located preferably in the backside of the bladder. The amount of energy comprised in the second harmonic or higher harmonic components of the received RF echo signal can be extracted and correlated to the amount of volume of urine that has been encompassed by the acoustic beam. Since harmonic generation is different in tissue than in fluids, only the' volume of urine that has been crossed by the acoustic beam would generate more harmonic energy. When the bladder is empty or below a certain volume level, no harmonic distortion occurs, whereas maximal distortion will be obtained for a full volume.

    [0051] Figure 9 illustrates the principle of the invention. Top panel shows two situations. The bladder is either empty (Panel A left side) or filled up with urine (Panel A right side). At a certain distance beyond the bladder (around 12 cm from the transducer), a region of interest of 1.5 cm width at depth W (see figure 7) is selected. Power spectra corresponding to echo signal recorded from the regions of interest are displayed in panel B.

    [0052] The spectrum corresponding to the empty bladder (solid line) shows only a fundamental component. The harmonic distortion is very weak so that no harmonic frequencies are generated. However, the echo signal corresponding to the filled bladder situation (dashed line) demonstrates clear distortion where a second harmonic component with a significant energy is generated. The third harmonic component can be also present with lesser energy depending on the urine volume that has been crossed by the acoustic beam.

    [0053] Figure 9 demonstrates that depending on the volume contained in the bladder that the acoustic beam has intersected, the amount of generated second harmonic energy varies. When the acoustic beam crosses only tissue or when the volume of urine is very small, harmonic distortion is the lowest with no or very low harmonic energy. If the bladder is filled up or if the volume of urine is above a certain level (threshold), harmonics are generated. The generation of a harmonic component (second and/or higher harmonics) can be used for volume measurement, or simply as an indicator of filling of the bladder to a certain volume extent. The criterion can be such that if a certain amount of second harmonic (or higher harmonics) is generated in the echo signal, the device would indicate that the critical volume (or threshold) (say in adult patients around 450 ml) has been reached.

    [0054] To avoid and eliminate any differences due to patient to patient variations, a normalization procedure needs to be performed a priori. Such a normalization procedure might consist of recording a first signal at very low transmit acoustic power from the same region of interest as described in the previous section. Such power would allow only linear propagation of the ultrasonic waves and avoid any harmonic generation. The echo signal would therefore have undergone only attenuation effects.

    [0055] In the following transmit-receive sequence, the transmit acoustic power is increased with a certain factor (e) and a new recording is performed from the same region of interest. This measure with a much higher acoustic pressure is carried out to allow harmonic distortion to occur in the tissue. The echo signal in this case will undergo both attenuation and distortion effects. The first echo signal (linear case) will be re-scaled by the factor that corresponded to the increase in transmit power (e), and then used as a reference signal. Consequently, each patient has his own reference hence eliminating any variations such as obesity, inhomogeneities, etc.

    [0056] A block diagram of a possible steps describing the second method is given in the flow chart of figure 8. The two transmitted signals might be transmitted with a very low repetition rate as indicated in figure 10. The first packet of transmit signals with low acoustic amplitude are used for calibration. The echoes received from those signals are averaged to reduce the noise level. The number of signals can be chosen such that a high signal-to-noise ratio is obtained. The second packet of signals with higher amplitudes are used to induce nonlinear propagation and harmonic distortion. The echoes received from these signals are averaged and then the harmonic energy is filtered and then compared to the calibration echo.

    [0057] In order to estimate the volume of urine in the bladder, a look-up table can be created beforehand. Such a table, saved in the hard disk of the electronic device, will contain the correspondence between the harmonic energy and the volume of urine. Such a table can be extracted from a curve similar to the one given in figure 11. Such a curve can be obtained from a "learning" patient set of measurements. Look-up tables may eventually be produced for specific patient groups for age; gender and/or weight as an input parameter.

    [0058] The described second method differs greatly from known other apparatus:

    12) The device is composed of a single element defocused ultrasound transducer with a conical beam shape;

    13) The single acoustic beam entirely encompasses the volumetric area of a possibly filled bladder.

    14) The method is based on measurement of non-linear properties and attenuation behavior of propagating ultrasound waves as influenced by a urine filled bladder.

    15) The method incorporates a technique to eliminate patient variation due to fat or skin properties.

    16) The method for automatic volume computation does not assume any geometrical model for the bladder shape;

    17) It is valid for any bladder shape since the received signal "integrates" all volume effects in the ultrasound beam.

    18) All known other methods use bladder wall echoes as a basis to calculate volume.

    19) The device works instantaneously.



    [0059] Other embodiments are intentionally within the scope of the accompanying claims.


    Claims

    1. An apparatus for measuring the volume of fluid in a human or animal body cavity (3) using a non-invasive, ultrasound echo technique, comprising:

    one or more transducers (1) configured to:

    transmit at least a first ultrasound signal (A-E) at a first power level into the body such that the at least one signal reaches a portion of the target body cavity (3) and does not generate harmonic components in an echo signal from the at least first ultrasound signal, the at least first ultrasound signal having a first frequency, and

    transmit at least a second ultrasound signal having the first frequency and at a second power level higher than the first power level;

    means for receiving at least a first ultrasound echo signal from the body cavity for the at least first ultrasound signal, and receiving at least a second ultrasound echo signal from the body cavity for the at least second ultrasound signal;

    means for using the received at least first ultrasound echo signal as a reference signal, wherein the reference signal is used as part of a normalization process to eliminate effects of patient variations;

    means for determining a measure of higher harmonic components of the received at least second ultrasound echo signal, wherein the harmonic components correspond to at least a second harmonic having at least two times the first frequency;

    means for re-scaling the reference signal based on an increase in power level between the first power level and the second power level; and

    means for determining a volume of fluid in the body cavity from the measured harmonic components and the re-scaled reference signal by:
    subtracting the re-scaled reference signal from the at least second ultrasound echo signal to generate a difference signal, filtering non-linear content from the difference signal to generate a value associated with the volume of fluid, and determining, based on the value, the volume of fluid using a look-up table.


     
    2. The apparatus of claim 1 adapted for use where the body cavity is a bladder (3) and the volume of fluid measured is a volume of urine.
     
    3. The apparatus of claim 2 in which the one or more transducers are adapted to transmit a signal (A-E) of ultrasound energy sufficient to reach portions of the entire human bladder (3).
     
    4. The apparatus of claim 1 further including means for selecting the received at least second ultrasound signal from within one or more predetermined depth ranges and using only those signals for the determination of volume of fluid in the body cavity.
     
    5. The apparatus of claim 1 or claim 3, where the one or more transducers comprise an ultrasound transducer which is a curved single active piezo-electric element, shaped to form a sector of a sphere or cone like sound beam.
     
    6. The apparatus of claim 1, where the one or more transducers comprise an ultrasound transducer combined with a lens material so that the combination of transducer and lens material create a wide sound beam to approximately reach all portions of the filled bladder.
     
    7. The apparatus of claim 1, where the one or more transducers comprise a transducer adapted to transmit at a fundamental ultrasound frequency and is adapted to receive the fundamental and higher harmonic signals of the transmitted frequency.
     
    8. The apparatus of claim 4 further including means for transmitting, at the fundamental frequency, a multiplicity of different pulses to enhance the higher harmonic components in the received signals.
     
    9. The apparatus of claim 1 further including means for selecting received signals from approximately a selected depth or distance, and wherein the selected depth or distance is beyond the posterior wall of an average filled human bladder.
     
    10. The apparatus of claim 1 further including means for determining the scattered power of higher harmonics in the received at least second ultrasound echo signal and comparing the scattered power with the backscattered power in the fundamental frequency in an algorithm to calculate the urine volume.
     
    11. The apparatus of claim 1 further including means for using combined pulse sequences at the first power level and the second power level to enhance bladder filling measurement and eliminate patient variation due to obesity.
     
    12. The apparatus of claim 1 further including means for using echo data from a depth close to the position of the average anterior bladder wall in determining volume of fluid to limit the effects of variation in the body proximal to the transducer.
     
    13. The apparatus of claim 1 further including means for varying the transmitted power in subsequent pulse transmissions, such that linear and non-linear echo signals from various depths can be compared to eliminate effects of patient variation.
     
    14. The apparatus of claim 1 further including a display adapted to indicate at least one of:

    (i) a volume above a predetermined threshold level, the threshold level being determined according to a specified medical application; or

    (ii) filling below a predetermined threshold level, the threshold level being determined according to a specified medical application.


     
    15. The apparatus of claim 1, where the one or more transducers comprises a combination of a first acoustic active surface for optimal transmission and reception at the fundamental frequency and second acoustic active surface for optimal reception of the higher harmonic echo signals.
     
    16. The apparatus of claim 1 having a transducer assembly including a plurality of ultrasound transducers mounted thereon and configured to transmit and receive a plurality of ultrasound signals into the body cavity at plural angles of incidence and/or from plural spatial locations and for providing a narrow beam direction in the dorsal direction which is used to detect the anterior and posterior bladder wall; this information is used for appropriate selection of the echo depth for proper recording of the higher harmonic echo signal.
     
    17. A method for measuring the volume of fluid in a human or animal body cavity using a non-invasive, ultrasound echo technique, comprising the steps of:

    using one or more transducers to transmit at least a first ultrasound signal at a first power level into the body such that the at least one signal reaches a portion of the target body cavity and does not generate harmonic components in an echo signal from the at least first ultrasound signal, the signal having at least a first frequency;

    transmitting, via the one or more transducers, at least a second ultrasound signal into the body and having the first frequency and at a second power level higher than the first power level;

    receiving a first ultrasound echo signal from the body cavity for the at least first ultrasound signal;

    using the first ultrasound echo signal as a reference signal in a normalization process to eliminate effects of patient variations;

    receiving a second ultrasound echo signal from the body cavity for the at least second ultrasound signal;

    re-scaling the reference signal based on an increase in power level between the first power level and the second power level;

    determining a measure of higher harmonic components of the received at least second ultrasound echo signal, wherein the high harmonic components correspond to at least a second harmonic of the first frequency; and

    determining a volume of fluid in the body cavity from the measured harmonic components and the reference signal by:
    subtracting the re-scaled reference signal from the at least second ultrasound echo signal to generate a difference signal, filtering non-linear content from the difference signal to generate a value associated with the volume of fluid, and determining, based on the value, the volume of fluid using a look-up table.


     
    18. The apparatus of claim 1 in which the at least one signal comprises a plurality of signals.
     


    Ansprüche

    1. Vorrichtung zum Messen des Fluidvolumens in einer menschlichen oder tierischen Körperhöhle (3) mittels einer nicht-invasiven Ultraschall-Echotechnik, die Folgendes umfasst:

    einen oder mehrere Wandler (1), die konfiguriert sind, um:

    mindestens ein erstes Ultraschallsignal (A-E) mit einem ersten Leistungspegel in den Körper zu übertragen, so dass das mindestens eine Signal einen Abschnitt der Zielkörperhöhle (3) erreicht und keine harmonischen Komponenten in einem Echosignal aus dem mindestens ersten Ultraschallsignal erzeugt, wobei das mindestens erste Ultraschallsignal eine erste Frequenz hat, und um mindestens ein zweites Ultraschallsignal mit der ersten Frequenz und mit einem zweiten Leistungspegel, der höher als der erste Leistungspegel ist, zu übertragen;

    Mittel zum Empfangen von mindestens einem ersten Ultraschall-Echosignal von der Körperhöhle für das mindestens erste Ultraschallsignal und zum Empfangen von mindestens einem zweiten Ultraschall-Echosignal von der Körperhöhle für das mindestens zweite Ultraschallsignal;

    Mittel zum Verwenden des empfangenen mindestens ersten Ultraschall-Echosignals als Referenzsignal, wobei das Referenzsignal als Teil eines Normalisierungsprozesses verwendet wird, um Auswirkungen von Patientenschwankungen auszuschließen;

    Mittel zum Bestimmen eines Maßes höherer harmonischer Komponenten des empfangenen mindestens zweiten Ultraschall-Echosignals, wobei die harmonischen Komponenten mindestens einer zweiten Harmonischen entsprechen, die mindestens das Zweifache der ersten Frequenz aufweist;

    Mittel zur Neuskalierung des Referenzsignals basierend auf einem Anstieg des Leistungspegels zwischen dem ersten Leistungspegel und dem zweiten Leistungspegel; und

    Mittel zum Bestimmen eines Fluidvolumens in der Körperhöhle aus den gemessenen harmonischen Komponenten und dem neuskalierten Referenzsignal, durch:

    Subtrahieren des neuskalierten Referenzsignals von dem mindestens zweiten Ultraschall-Echosignal, um ein Differenzsignal zu erzeugen, Filtern des nichtlinearen Inhalts aus dem Differenzsignal, um einen dem Flüssigkeitsvolumen zugeordneten Wert zu erzeugen, und Bestimmen des Fluidvolumens auf der Grundlage des Wertes mittels einer Nachschlagetabelle.


     
    2. Vorrichtung nach Anspruch 1, geeignet zur Verwendung in Fällen, in denen die Körperhöhle eine Blase (3) und das gemessene Fluidvolumen ein Urinvolumen ist.
     
    3. Vorrichtung nach Anspruch 2, bei der ein oder mehrere Wandler so angepasst sind, dass sie ein Signal (A-E) mit Ultraschallenergie übertragen, das ausreicht, um Abschnitte der gesamten menschlichen Blase zu erreichen (3).
     
    4. Vorrichtung nach Anspruch 1, die ferner Mittel zum Auswählen des empfangenen mindestens zweiten Ultraschallsignals aus einem oder mehreren vorbestimmten Tiefenbereichen und zum Verwenden nur dieser Signale für die Bestimmung des Fluidvolumens in der Körperhöhle enthält.
     
    5. Vorrichtung nach Anspruch 1 oder 3, bei der der eine oder die mehreren Wandler einen Ultraschallwandler umfassen, der ein gekrümmtes einzelnes aktives piezoelektrisches Element ist, das so geformt ist, dass es einen Sektor einer Kugel oder eines Kegels wie ein Schallstrahl bildet.
     
    6. Vorrichtung nach Anspruch 1, bei der ein oder mehrere Wandler einen Ultraschallwandler umfassen, der mit einem Linsenmaterial kombiniert ist, so dass die Kombination aus Wandler und Linsenmaterial einen breiten Schallstrahl erzeugt, um annähernd alle Abschnitte der gefüllten Blase zu erreichen.
     
    7. Vorrichtung nach Anspruch 1, bei der der eine oder die mehreren Wandler einen Wandler umfassen, der geeignet ist, bei einer Ultraschallgrundfrequenz zu übertragen, und der geeignet ist, die Grund- und höheren harmonischen Signale der übertragenen Frequenz zu empfangen.
     
    8. Vorrichtung nach Anspruch 4, die ferner Mittel zum Übertragen einer Vielzahl von verschiedenen Impulsen bei der Grundfrequenz enthält, um die höheren harmonischen Komponenten in den empfangenen Signalen zu verstärken.
     
    9. Vorrichtung nach Anspruch 1, die ferner Mittel zum Auswählen empfangener Signale aus ungefähr einer ausgewählten Tiefe oder Entfernung enthält, und wobei die ausgewählte Tiefe oder Entfernung außerhalb der hinteren Wand einer durchschnittlich gefüllten menschlichen Blase liegt.
     
    10. Vorrichtung nach Anspruch 1 enthält ferner Mittel zum Bestimmen der Streuleistung der höheren Harmonischen in dem empfangenen mindestens zweiten Ultraschall-Echosignal und zum Vergleichen der Streuleistung mit der Rückstreuleistung in der Grundfrequenz in einem Algorithmus zur Berechnung des Urinvolumens.
     
    11. Vorrichtung nach Anspruch 1, die ferner Mittel zum Verwenden kombinierter Impulsfolgen auf dem ersten Leistungspegel und dem zweiten Leistungspegel enthält, um die Messung der Blasenfüllung zu verbessern und durch Fettleibigkeit bedingte Patientenschwankungen auszuschließen.
     
    12. Vorrichtung nach Anspruch 1, die ferner Mittel zur Verwendung von Echodaten aus einer Tiefe nahe der Position der durchschnittlichen vorderen Blasenwand zum Bestimmen des Fluidvolumens enthält, um die Auswirkungen von Schwankungen im Körper proximal des Wandlers zu begrenzen.
     
    13. Vorrichtung nach Anspruch 1, die ferner Mittel zum Verändern der übertragenen Leistung bei nachfolgenden Impulsübertragungen enthält, so dass lineare und nichtlineare Echosignale aus verschiedenen Tiefen verglichen werden können, um die Auswirkungen der Patientenschwankungen auszuschließen.
     
    14. Vorrichtung nach Anspruch 1, die ferner eine Anzeige enthält, die so angepasst ist, dass sie mindestens eines der Folgenden anzeigt:

    (i) ein Volumen über einem vorbestimmten Schwellenwert, wobei der Schwellenwert gemäß einer vorgegebenen medizinischen Anwendung bestimmt wird; oder

    (ii) Füllen unter einem vorgegebenen Schwellenwert, wobei der Schwellenwert nach einer vorgegebenen medizinischen Anwendung bestimmt wird.


     
    15. Vorrichtung nach Anspruch 1, wobei der eine oder mehrere Wandler für eine optimale Übertragung und den Empfang bei der Grundfrequenz und die zweite akustische aktive Oberfläche für den optimalen Empfang der höheren harmonischen Echosignale, die eine Kombination aus einer ersten akustischen aktiven Oberfläche umfassen.
     
    16. Vorrichtung nach Anspruch 1 mit einer Wandlerbaugruppe, die mehrere Ultraschallwandler enthält, die darauf montiert und konfiguriert sind, um mehrere Ultraschallsignale in die Körperhöhle unter mehreren Einfallswinkeln und/oder von mehreren räumlichen Orten aus zu übertragen und zu empfangen und um eine schmale Strahlrichtung in der dorsalen Richtung bereitzustellen, die verwendet wird, um die vordere und hintere Blasenwand zu erfassen;
    diese Informationen werden zur geeigneten Auswahl der Echotiefe für das ordnungsgemäße Aufzeichnen des Echosignals mit höherer Harmonischer verwendet.
     
    17. Verfahren zum Messen des Fluidvolumens in einer menschlichen oder tierischen Körperhöhle mittels einer nichtinvasiven Ultraschall-Echotechnik, das die folgenden Schritte umfasst:

    Verwenden eines oder mehrerer Wandler, um mindestens ein erstes Ultraschallsignal mit einem ersten Leistungspegel in den Körper zu übertragen, so dass das mindestens eine Signal einen Abschnitt der Zielkörperhöhle erreicht und keine harmonischen Komponenten in einem Echosignal aus dem mindestens ersten Ultraschallsignal erzeugt, wobei das Signal mindestens eine erste Frequenz hat;

    Übertragen, über einen oder mehrere Wandler, mindestens eines zweiten Ultraschallsignals in den Körper mit der ersten Frequenz und bei einem zweiten Leistungspegel, der höher ist als der erste Leistungspegel;

    Empfangen eines ersten Ultraschall-Echosignals aus der Körperhöhle für das mindestens erste Ultraschallsignal;

    Verwenden des ersten Ultraschall-Echosignals als Referenzsignal in einem Normalisierungsprozess, um die Auswirkungen von Patientenschwankungen auszuschließen;

    Empfangen eines zweiten Ultraschall-Echosignals von der Körperhöhle für das mindestens zweite Ultraschallsignal;

    Neuskalieren des Referenzsignals basierend auf einer Erhöhung des Leistungspegels zwischen dem ersten Leistungspegel und dem zweiten Leistungspegel;

    Bestimmen eines Maßes der höheren harmonischen Komponenten des empfangenen mindestens zweiten Ultraschall-Echosignals, wobei die hohen harmonischen Komponenten mindestens einer zweiten Harmonischen der ersten Frequenz entspricht; und

    Bestimmen eines Fluidvolumens in der Körperhöhle aus den gemessenen harmonischen Komponenten und dem Referenzsignal durch:
    Subtrahieren des neuskalierten Referenzsignals von dem mindestens zweiten Ultraschall-Echosignal, um ein Differenzsignal zu erzeugen, Filtern des nichtlinearen Inhalts aus dem Differenzsignal, um einen dem Flüssigkeitsvolumen zugeordneten Wert zu erzeugen, und Bestimmen des Fluidvolumens auf der Grundlage des Wertes mittels einer Nachschlagetabelle.


     
    18. Vorrichtung nach Anspruch 1, bei der das mindestens eine Signal mehrere Signale umfasst.
     


    Revendications

    1. Appareil permettant de mesurer le volume de fluide dans une cavité corporelle humaine ou animale (3) en utilisant une technique d'écho ultrasonore non invasive, comprenant :

    un ou plusieurs transducteurs (1) configurés pour :

    transmettre au moins un premier signal ultrasonore (AE) à un premier niveau de puissance dans le corps de telle sorte que ledit au moins un signal atteint une partie de la cavité corporelle cible (3) et ne génère pas de composantes harmoniques dans un signal d'écho provenant dudit au moins premier signal ultrasonore, ledit au moins premier signal ultrasonore ayant une première fréquence, et transmettre au moins un second signal ultrasonore ayant la première fréquence et à un second niveau de puissance supérieur au premier niveau de puissance ;

    des moyens permettant de recevoir au moins un premier signal d'écho ultrasonore de la cavité corporelle pour ledit au moins premier signal ultrasonore, et recevoir au moins un second signal d'écho ultrasonore de la cavité corporelle pour ledit au moins second signal ultrasonore ;

    des moyens pour utiliser ledit au moins premier signal d'écho ultrasonore reçu comme signal de référence, dans lequel le signal de référence est utilisé dans le cadre d'un processus de normalisation pour éliminer les effets des variations du patient ;

    des moyens permettant de déterminer une mesure de composantes harmoniques supérieures dudit au moins second signal d'écho ultrasonore reçu, dans lequel les composantes harmoniques correspondent à au moins une seconde harmonique ayant au moins deux fois la première fréquence ;

    des moyens permettant de redimensionner le signal de référence en fonction d'une augmentation du niveau de puissance entre le premier niveau de puissance et le second niveau de puissance ; et

    des moyens permettant de déterminer un volume de fluide dans la cavité corporelle à partir des composantes harmoniques mesurées et du signal de référence redimensionné en :

    soustrayant le signal de référence redimensionné dudit au moins second signal d'écho ultrasonore afin de générer un signal de différence, filtrant le contenu non linéaire du signal de différence afin de générer une valeur associée au volume de fluide et déterminant, en fonction de la valeur, le volume de fluide à l'aide d'une table de consultation.


     
    2. Appareil selon la revendication 1 adapté pour une utilisation où la cavité corporelle est une vessie (3) et le volume de fluide mesuré est un volume d'urine.
     
    3. Appareil selon la revendication 2, dans lequel le ou les transducteurs sont adaptés pour transmettre un signal (AE) d'énergie ultrasonore suffisant pour atteindre des parties de la vessie humaine entière (3).
     
    4. Appareil selon la revendication 1, comprenant en outre des moyens permettant de sélectionner ledit au moins second signal ultrasonore reçu dans une ou plusieurs plages de profondeur prédéterminées et en utilisant uniquement ces signaux pour la détermination du volume de fluide dans la cavité corporelle.
     
    5. Appareil selon la revendication 1 ou la revendication 3, dans lequel le ou les transducteurs comprennent un transducteur à ultrasons qui est un élément piézoélectrique actif unique incurvé, façonné pour former un secteur d'une sphère ou d'un cône comme un faisceau sonore.
     
    6. Appareil selon la revendication 1, dans lequel le ou les transducteurs comprennent un transducteur à ultrasons combiné à un matériau de lentille de sorte que la combinaison du transducteur et du matériau de lentille crée un large faisceau sonore pour atteindre approximativement toutes les parties de la vessie remplie.
     
    7. Appareil selon la revendication 1, dans lequel le ou les transducteurs comprennent un transducteur adapté pour émettre à une fréquence ultrasonore fondamentale et est adapté pour recevoir les fondamentaux et les signaux harmoniques supérieurs de la fréquence transmise.
     
    8. Appareil selon la revendication 4, comprenant en outre des moyens permettant de transmettre, à la fréquence fondamentale, une multiplicité d'impulsions différentes afin d'améliorer les composantes harmoniques supérieures dans les signaux reçus.
     
    9. Appareil selon la revendication 1, comprenant en outre des moyens permettant de choisir des signaux reçus à partir d'une profondeur ou d'une distance sélectionnée, et dans lequel la profondeur ou la distance choisie est au-delà de la paroi postérieure d'une vessie humaine remplie moyenne.
     
    10. Appareil selon la revendication 1, comprenant en outre des moyens permettant de déterminer la puissance diffusée des harmoniques supérieures dans ledit au moins second signal d'écho ultrasonore reçu et de comparer la puissance diffusée avec la puissance rétrodiffusée dans la fréquence fondamentale dans un algorithme pour calculer le volume d'urine.
     
    11. Appareil selon la revendication 1, comprenant en outre des moyens permettant d'utiliser des séquences d'impulsions combinées au premier niveau de puissance et au second niveau de puissance afin d'améliorer la mesure du remplissage de la vessie et d'éliminer la variation du patient due à l'obésité.
     
    12. Appareil selon la revendication 1, comprenant en outre des moyens permettant d'utiliser des données d'écho d'une profondeur proche de la position de la paroi moyenne de la vessie antérieure pour déterminer le volume de fluide afin de limiter les effets de variation dans le corps à proximité du transducteur.
     
    13. Appareil selon la revendication 1, comprenant en outre des moyens permettant de faire varier la puissance transmise dans les transmissions d'impulsions suivantes, de sorte que les signaux d'écho linéaires et non linéaires de différentes profondeurs peuvent être comparés afin d'éliminer les effets de la variation du patient.
     
    14. Appareil selon la revendication 1, comprenant en outre un affichage adapté pour indiquer au moins l'un parmi :

    (i) un volume supérieur à un niveau seuil prédéterminé, le niveau seuil étant déterminé selon une application médicale spécifiée ; ou

    (ii) un remplissage en dessous d'un niveau seuil prédéterminé, le niveau seuil étant déterminé selon une application médicale spécifiée.


     
    15. Appareil selon la revendication 1, dans lequel le ou les transducteurs comprennent une combinaison d'une première surface active acoustique pour une transmission et une réception optimales à la fréquence fondamentale et une second surface active acoustique pour une réception optimale des signaux d'écho harmoniques supérieurs.
     
    16. Appareil selon la revendication 1, ayant un ensemble transducteur comprenant une pluralité de transducteurs à ultrasons montés sur celui-ci et configurés pour transmettre et recevoir une pluralité de signaux ultrasonores dans la cavité corporelle à plusieurs angles d'incidence et/ou à partir de plusieurs emplacements spatiaux et pour fournir une direction étroite du faisceau dans la direction dorsale qui est utilisée pour détecter la paroi vésicale antérieure et postérieure ;
    ces informations sont utilisées pour une sélection appropriée de la profondeur d'écho pour un enregistrement correct du signal d'écho harmonique supérieur.
     
    17. Procédé de mesure du volume de fluide dans une cavité corporelle humaine ou animale en utilisant une technique d'écho ultrasonore non invasive, comprenant les étapes suivantes consistant à :

    utiliser un ou plusieurs transducteurs pour transmettre au moins un premier signal ultrasonore à un premier niveau de puissance dans le corps de telle sorte que ledit au moins un signal atteint une partie de la cavité corporelle cible et ne génère pas de composantes harmoniques dans un signal d'écho provenant dudit au moins premier signal ultrasonore, le signal ayant au moins une première fréquence ;

    transmettre, par l'intermédiaire du ou des transducteurs, au moins un second signal ultrasonore dans le corps et ayant la première fréquence et à un second niveau de puissance supérieur au premier niveau de puissance ;

    recevoir un premier signal d'écho ultrasonore de la cavité corporelle pour ledit au moins premier signal ultrasonore ;

    utiliser le premier signal d'écho ultrasonore comme signal de référence dans un processus de normalisation pour éliminer les effets des variations du patient ;

    recevoir un second signal d'écho ultrasonore de la cavité corporelle pour ledit au moins second signal ultrasonore ;

    redimensionner le signal de référence sur la base d'une augmentation du niveau de puissance entre le premier niveau de puissance et le second niveau de puissance ;

    déterminer une mesure de composantes harmoniques supérieures dudit au moins second signal d'écho ultrasonore reçu, dans lequel les composantes harmoniques élevées correspondent à au moins une seconde harmonique de la première fréquence ; et

    déterminer un volume de fluide dans la cavité corporelle à partir des composantes harmoniques mesurées et du signal de référence en :
    soustrayant le signal de référence redimensionné dudit au moins second signal d'écho ultrasonore afin de générer un signal de différence, filtrant le contenu non linéaire du signal de différence afin de générer une valeur associée au volume de fluide et déterminant, en fonction de la valeur, le volume de fluide à l'aide d'une table de consultation.


     
    18. Appareil selon la revendication 1, dans lequel ledit au moins un signal comprend une pluralité de signaux.
     




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    REFERENCES CITED IN THE DESCRIPTION



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    Non-patent literature cited in the description