Alpine Spine & Orthopedics - Diagnostic & Interventional Ultrasound Imaging

Ultrasound Imaging

High-resolution diagnostics & interventional ultrasound-guided procedures

New advances in engineering have enabled ultrasound devices to provide higher resolution, more diagnostic information, and better image-guidance than ever before, and we frequently post videos showing the utility of live ultrasound imaging in assessing many types of anatomic abnormalities and performing therapeutic interventions for many types of injuries and conditions on our Instagram page, Facebook page, and YouTube channel.

We use ultrasound imaging for rapid diagnostics of a wide range of musculoskeletal, nerve, joint, cardiac and vascular disorders. Ultrasound is capable of high-resolution imaging of muscle, tendon, ligament, nerve, vessels, cartilage, bone, and joint injuries in elbows, wrists, hands, fingers, shoulders, spine, hips, knees, ankles, feet, and nearly everywhere else in the body. Thus ultrasound is an ideal tool for visualizing muscle, tendon, ligament, joint, cartilage, and nerve injuries, in many cases performing as good as or even better than MRI resolution (down to 100 microns!) with the added benefit of real-time imaging and interventional image-guidance (1) (2). We can also do minimally-invasive nano needle arthroscopy for additional views and image-guided targeting and repair of defects, and we can do echocardiography and vascular ultrasound imaging for vascular studies for complex venous access and atherosclerotic disease assessment using aortic and carotid intima-media thickness (CIMT) analysis (3) to screen for carotid artery atherosclerosis and abdominal aortic aneurysms along with peripheral artery disease.

We also offer trans-cranial doppler (TCD) imaging and measurements of cerebrovascular flow that has been shown to detect specific pathologic changes in traumatic brain injury, stroke, vasospasm, micro-emboli, atherosclerosis, headaches, Alzheimers disease, dementia, and many other cerebrovascular disorders (4a) (4b) (4c). Doppler ultrasound technology can also be used for temporary opening of the blood-brain barrier (along with microbubble ultrasonic resonance techniques) for medication delivery directly to central neural tissue (5) (6) as well as for velocity and flow measurements.

Furthermore, ultrasound is incredibly useful for interventions in a wide variety of orthopedic, musculoskeletal, joint, nerve, spine, organ, and soft tissue pathologies and injuries. Our wireless scanners also dramatically expand mobile wilderness medicine capabilities and enable image-guided procedures in the clinic, in emergency traumas, and in the field in remote areas. Only ultrasound enables many useful interactive capabilities and live dynamic imaging of soft tissues, including cardiac function, blood flow and vascular access, lung pathologies, and even bone and joint injuries-- so if a particular motion is causing pain, we can see a live image of what is happening deep in the tissue during the motion. X-rays are typically not helpful for imaging soft tissues and are even notorious for missing several types of fractures and joint injuries, whereas ultrasound can actually be better for imaging cartilage and ligament injuries and cortical bone fractures than x-rays or MRI (7) (8) (9), especially injuries of ligaments, tendons, nerves, muscles, synovial joint capsules, inflammed joints, stress fractures, occult foreign bodies, etc., plus it does not expose to any ionizing radiation like X-rays or CT scans.

Furthermore ultrasound can be used for direct live visualization and guidance of targeted needle injections and optimized interventional procedures that target and repair the exact injury site without unnecessarily damaging other important structures or adjacent tissue. Additional features like beam-steering, color doppler, power doppler, spectral analysis, time-gain compensation, and artificial-intelligence enhancement algorithms provide even further targeting capabilities and resolving power of tissue pathologies. Thus ultrasound can provide useful information for all diagnoses listed on our conditions page in a fast, dynamic, and cost-efficient package. In addition, our mobile ultrasound device enables us to run a mobile clinic where we can not only diagnose complex injuries but also quickly obtain immensely useful information on tissue and organ functions even in remote expedition environments, including cardiac function using trans-thoracic echocardiogram, lung evaluations looking for pulmonary infections, edema, or effusions at high altitude, assessment of bowel and bladder functions, soft tissue wound infections, numerous types of musculoskeletal and joint injuries, as well as vital and complex vascular access.

Dr. McMurtrey is one of the only surgeons who also holds a Biomedical Engineering degree and understands the complexities of low and high-intensity focused ultrasound (HIFU & LIFU). We hope to apply these technologies to cases of Parkinson's disease, Alzheimer's disease, neurodegenerative diseases, blood-brain barrier delivery, and other future applications (10). At the University of Oxford, Dr. McMurtrey pioneered new regenerative tissue engineering techniques and new applications of ultrasonics in imaging, diagnostics, tissue repair, tumor ablation, and minimally-invasive interventions, and he also won top awards for his innovative design of novel medical devices. He is also interested in studying ultrasound's ability to temporarily open the blood-brain barrier permeability for delivery of stem cells, peptides, chemotherapy, or other agents through a less invasive means than intrathecal injections. For those interested in the physics of ultrasound and its new applications in innovative therapeutics, you can read his introductory engineering summary of ultrasonics and biomechanics in PDF form. Dr. McMurtrey has also taught and participated in nearly 100 hours of continuing education courses on diagnostic ultrasound radiology interpretation and image-guided interventional procedures. We are also involved in advancing direct visualization with minimally-invasive endoscopic approaches and bringing in the next generation of 3D scanners to enable ultra-high resolution 3D reconstructions for analysis of spatial anatomy, injuries, and pathologies in patients in near real-time during procedures and interventions.

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