7 ms·

Focused Ultrasound

163 points by birriel 3y ago

aaron695 3y ago
The Tricorder moonshot was a stupid waste of time with their impossible stupid rules. A cheap conventual ultrasound in a stick would be a tricorder moment. Hook in a mobile phone and 3D analyzing humans or pets or livestock or many inanimate things becomes software. This is cool and all, but unless you get the tech out of their hands it'll go nowhere for decades. Just like we've stagnated with conventual ultra sound. The cost needs to be smashed down. It shouldn't take a moonshot. This is old tech that's not hugely complicated. Get these down to $50 - https://www.aliexpress.com/w/wholesale-ultrasound-transducers.html https://www.aliexpress.com/w/wholesale-ultrasound-transducer...
- MauranKilom 3y ago
  Not completely objecting to this idea, but even in ideal scenarios with high-tech hardware and specialized setup, getting useful US image quality can be non-trivial and requires training and expertise. I can conceivably see that these are to some extent technical limitations that can be overcome for some level of mass-adoption. However, I don't see what use cases you have in mind that don't require a doctor for interpretation anyway (in which case having a professional device and the required expertise present in the facility is much simpler and cheaper than putting it in the hands of every patient). But also, particularly for pets I believe anything with a non-negligible amount of fur or similar (i.e. anything that is not just bare skin) will be fundamentally impossible to achieve good enough acoustic coupling for. Unless you also sell shaving equipment with it. Anything with bone in the way (e.g. a ribcage with gaps smaller than a human one) is also more or less out. For inanimate objects I really wonder what use cases you have in mind. Acoustic properties (and coupling) are even more of a variable there...
- mschuster91 3y ago
  > The cost needs to be smashed down. It shouldn't take a moonshot. This is old tech that's not hugely complicated. The tech is not the problem, the certifications are. It's incredibly expensive and onerous to bring new medical device designs to market, and for good reasons - if it were easier, you'd get even more quackery than you already have now (e.g. homeopathy, penis enhancement pills, "nutritional" supplements). The same is true for airplanes. Your run-off-the-mill Cessna? Its design dates back to the 50s. Almost all of GA still runs with fucking lead in the fuel because it took the FAA over 12 years to get it certified, and even in the US it is estimated to take until 2026 (!) until G100UL is widely available. Europe doesn't even have a timeframe. [1] https://en.wikipedia.org/wiki/Avgas#G100UL https://en.wikipedia.org/wiki/Avgas#G100UL
_Microft 3y ago
Via Nitter: https://nitter.net/FutureJurvetson/status/1708306322729607596 https://nitter.net/FutureJurvetson/status/170830632272960759...
minihat 3y ago
Not a secret to the research community... Let me balance the hype with some of the remaining challenges. Depth is a problem; the deeper you go, the less effective it is. Heat is another issue; you can inadvertently damage nearby tissue. Targeting accuracy is vital, especially near critical structures (think nerves), and we're not at sub-millimeter precision yet. Also, real-time monitoring like MRI-guided FUS is expensive and complicated, and without it you have to guess that you're affecting the right tissue. Great promise, but multiple engineering hurdles to clear before FUS lives up to the hype.
- denton-scratch 3y ago
  > and we're not at sub-millimeter precision yet How do you get sub-millimeter precision with ultrasound? At 300KHz, the sound has a wavelength of 1mm. My understanding is that sound with a frequency greater than about 150Khz dissipates after passing through 5cms of air; it must dissipate faster in flesh. Also, a wavelength of 1mm should give you a resolution of about 4mm, right? I wish I knew more about the propagation of ultrasound; I'm getting interested in the bats that live around here.
  - polishdude20 3y ago
    Isn't this like saying how can we move something one millimeter if our fingers are bigger than one millimeter?
    - aesh2Xa1 3y ago
      Yes, I think it is like saying that, but I also think that OP was considering targets less than 4mm in size. The focus of the FUS wave being no smaller than 4mm, very small targets would be larger than the smallest focus. It's like saying "how can a syringe extract the cytoplasm of a cell?" if you take OP's angle.
      - polishdude20 3y ago
        Ah I guess in the case of ultrasound, the thing you're trying to do is not nudge or move something, you're literally trying to "ablate" or hit it and only it. That's more like pressing a tiny button with your finger and trying not to touch the outside of the button.
gadders 3y ago
I recently learnt about this procedure for prostate cancer - TULSA (Transurethral Ultrasound Ablation) https://buschcenter.com/tulsa-procedure/ https://buschcenter.com/tulsa-procedure/
- elcritch 3y ago
  NIH study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9579879/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9579879/
- deleted 3y ago
  [deleted]
jharohit 3y ago
Interesting - have a friend going through Prostate Cancer and all docs here in Singapore have suggested surgery + chemo. I noticed in Steve's shared PDF that Prostate Cancer has already crossed the FDA Approval and Reimbursement stage. Anyone had any personal experiences in using HIFU (high intensity focussed ultrasound)? Specifically the stage up to which it is effective over surgery+chemo My data sources: - https://cdn.fusfoundation.org/2023/02/06115144/Focused-Ultrasound-Foundation_State-of-the-Field-Report-2022_Jan-18.pdf#page=16 https://cdn.fusfoundation.org/2023/02/06115144/Focused-Ultra... - https://www.mayoclinic.org/medical-professionals/urology/news/high-intensity-focused-ultrasound-for-the-treatment-of-prostate-cancer/mqc-20519431 https://www.mayoclinic.org/medical-professionals/urology/new...
- gadders 3y ago
  You might find this podcast of interest. The guy talks about his experience of the TULSA procedure. They're kind of cynical about the state of prostate treatment in general but seem keen on this procedure. https://www.podchaser.com/podcasts/starting-strength-radio-9575/episodes/greg-ellifritz-cancer-treatmen-187310706 https://www.podchaser.com/podcasts/starting-strength-radio-9...
thrwyfrths 3y ago
I’ve always wondered what happened to Steve Jurvetson. He laid low for a while after resigning from the Tesla Board of Directors. I see he is active on Twitter/X now.
- cinntaile 3y ago
  Isn't every VC investor basically a "thought leader" on Twitter? I assume it helps with deal flow?
- iancmceachern 3y ago
  He had that whole issue with impropriety and sexual harassment at DFJ, that's what happened.
latchkey 3y ago
When I was a kid, I fell on my wrist. It healed up badly and formed a lot of calcium deposits around the bones. I couldn't bend my wrist backwards more than a couple degrees and it was painful. Went to a PT who used ultrasound treatments and stretching to break down the deposits, which freed my wrist up. This was in the 1980's.
- whatshisface 3y ago
  Dealing acoustically with something different from the surrounding material (calcium deposits) is a lot easier than focusing on tissues with roughly the acoustic properties of water among other tissues with the acoustic properties of water - in the former case the stuff can distinguish itself w.r.t. application of the waves, the latter requires focusing to come "from the outside."
- tomek_ycomb 3y ago
  Ultrasonics have been used for kidney stones for a while, too. But, this is something different as noted elsewhere
tommiegannert 3y ago
The gamma knife is a similar idea, but using gamma radiation focusing: https://www.mayoclinic.org/tests-procedures/brain-stereotactic-radiosurgery/about/pac-20384679#dialogId49199783 https://www.mayoclinic.org/tests-procedures/brain-stereotact... Edit: similar idea
izoow 3y ago
I remember randomly visiting a lecture of one of my professors that specializes in high performance computing, he was showing off the research they do and it was regarding computing the necessary "parameters" for this. Apparently calculating the parameters for a single patient to focus just the right spot and not damage anything is a task that takes several hours on a supercomputer. This might've been like 5 years ago.
glfharris 3y ago
Describing it as a best kept secret seems unnecessarily adversarial. The medical community aren't jealously guarding treatments from the populace. Arguably shock wave lithotripsy, a common method for breaking up kidney stones, could be described as focused ultrasound.
- mmastrac 3y ago
  I think it's a figure of speech meaning that it's just not widely known.
- jhallenworld 3y ago
  It seems they are considering it for kidney stones, perhaps in addition to lithotripsy: https://www.fusfoundation.org/diseases-and-conditions/kidney-stones/ https://www.fusfoundation.org/diseases-and-conditions/kidney... Lithotripsy is pretty limited, I think the preference in most cases is to use ureteroscopy (using holmium laser ablation to break up stones).. but as someone who's had this, I can tell you it's no fun- any progress would be welcome.
bobim 3y ago
Meh? It’s been on the French health market for at least two decades (Ablatherm). It’s effective for people that wouldn’t bear anesthesia but it comes with some limitations. It can’t be used when there are bones, lungs or non-uniform propagation medium in front of the target. And while the tissues are burnt their mechanical properties are evolving and deflecting the beam. The cavitation due to negative alternance of pressure waves puts a limit on the power. Perfusion can take the heat away, etc… It’s probably not widely used because conventional surgery is often more practical.
caycep 3y ago
From the brain side, those of us who remember the pallidotomy and thalamotomy days, the "noninvasive" part is a marketing misnomer. It's invasive (it's a lesioning/ablation therapy); it just doesn't require a pallidotomy. But it's a shockingly effective tactic; there's a steady stream of patients rolling in the office with mild symptoms who are willingly requesting to have a hole burned in their head. (Also it's turning out not to be nearly as effective in treating symptoms as deep brain stimulation)
- caycep 3y ago
  *edit "doesn't require a craniotomy" - the procedure is a thalamotomy.
aheilbut 3y ago
related practical application https://www.beckman.com/liquid-handlers/echo-acoustic-technology https://www.beckman.com/liquid-handlers/echo-acoustic-techno...
38 3y ago
non crap link: http://farside.link/twitter.com/FutureJurvetson/status/1708306322729607596 http://farside.link/twitter.com/FutureJurvetson/status/17083...
interfacer 3y ago
If you are interested in learning more about focused ultrasound there is a great python toolbox that allows you generate simulations, change parameters, visualize results, etc. https://agencyenterprise.github.io/neurotechdevkit/ https://agencyenterprise.github.io/neurotechdevkit/ From the repo “The Neurotech Development Kit (NDK) is an open-source, community-driven software library designed to lower the barrier of entry to the next generation of neurotechnology for current researchers and companies. It also enables software developers without access to hardware and human subjects to solve open problems in the field. The initial release of NDK provides support for transcranial focused ultrasound stimulation, along with comprehensive documentation, API flexibility, and 2D/3D visualizations. Future areas of interest may include photoacoustic and optical whole-brain imaging.”

163 points by birriel 3y ago

The Tricorder moonshot was a stupid waste of time with their impossible stupid rules. A cheap conventual ultrasound in a stick would be a tricorder moment. Hook in a mobile phone and 3D analyzing humans or pets or livestock or many inanimate things becomes software. This is cool and all, but unless you get the tech out of their hands it'll go nowhere for decades. Just like we've stagnated with conventual ultra sound. The cost needs to be smashed down. It shouldn't take a moonshot. This is old tech that's not hugely complicated. Get these down to $50 - https://www.aliexpress.com/w/wholesale-ultrasound-transducers.html https://www.aliexpress.com/w/wholesale-ultrasound-transducer...

MauranKilom 3y ago
Not completely objecting to this idea, but even in ideal scenarios with high-tech hardware and specialized setup, getting useful US image quality can be non-trivial and requires training and expertise. I can conceivably see that these are to some extent technical limitations that can be overcome for some level of mass-adoption. However, I don't see what use cases you have in mind that don't require a doctor for interpretation anyway (in which case having a professional device and the required expertise present in the facility is much simpler and cheaper than putting it in the hands of every patient). But also, particularly for pets I believe anything with a non-negligible amount of fur or similar (i.e. anything that is not just bare skin) will be fundamentally impossible to achieve good enough acoustic coupling for. Unless you also sell shaving equipment with it. Anything with bone in the way (e.g. a ribcage with gaps smaller than a human one) is also more or less out. For inanimate objects I really wonder what use cases you have in mind. Acoustic properties (and coupling) are even more of a variable there...
mschuster91 3y ago
> The cost needs to be smashed down. It shouldn't take a moonshot. This is old tech that's not hugely complicated. The tech is not the problem, the certifications are. It's incredibly expensive and onerous to bring new medical device designs to market, and for good reasons - if it were easier, you'd get even more quackery than you already have now (e.g. homeopathy, penis enhancement pills, "nutritional" supplements). The same is true for airplanes. Your run-off-the-mill Cessna? Its design dates back to the 50s. Almost all of GA still runs with fucking lead in the fuel because it took the FAA over 12 years to get it certified, and even in the US it is estimated to take until 2026 (!) until G100UL is widely available. Europe doesn't even have a timeframe. [1] https://en.wikipedia.org/wiki/Avgas#G100UL https://en.wikipedia.org/wiki/Avgas#G100UL

_Microft 3y ago

Via Nitter: https://nitter.net/FutureJurvetson/status/1708306322729607596 https://nitter.net/FutureJurvetson/status/170830632272960759...

minihat 3y ago

Not a secret to the research community... Let me balance the hype with some of the remaining challenges. Depth is a problem; the deeper you go, the less effective it is. Heat is another issue; you can inadvertently damage nearby tissue. Targeting accuracy is vital, especially near critical structures (think nerves), and we're not at sub-millimeter precision yet. Also, real-time monitoring like MRI-guided FUS is expensive and complicated, and without it you have to guess that you're affecting the right tissue. Great promise, but multiple engineering hurdles to clear before FUS lives up to the hype.

denton-scratch 3y ago
> and we're not at sub-millimeter precision yet How do you get sub-millimeter precision with ultrasound? At 300KHz, the sound has a wavelength of 1mm. My understanding is that sound with a frequency greater than about 150Khz dissipates after passing through 5cms of air; it must dissipate faster in flesh. Also, a wavelength of 1mm should give you a resolution of about 4mm, right? I wish I knew more about the propagation of ultrasound; I'm getting interested in the bats that live around here.
- polishdude20 3y ago
  Isn't this like saying how can we move something one millimeter if our fingers are bigger than one millimeter?
  - aesh2Xa1 3y ago
    Yes, I think it is like saying that, but I also think that OP was considering targets less than 4mm in size. The focus of the FUS wave being no smaller than 4mm, very small targets would be larger than the smallest focus. It's like saying "how can a syringe extract the cytoplasm of a cell?" if you take OP's angle.
    - polishdude20 3y ago
      Ah I guess in the case of ultrasound, the thing you're trying to do is not nudge or move something, you're literally trying to "ablate" or hit it and only it. That's more like pressing a tiny button with your finger and trying not to touch the outside of the button.

gadders 3y ago

I recently learnt about this procedure for prostate cancer - TULSA (Transurethral Ultrasound Ablation) https://buschcenter.com/tulsa-procedure/ https://buschcenter.com/tulsa-procedure/

elcritch 3y ago
NIH study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9579879/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9579879/
deleted 3y ago
[deleted]

jharohit 3y ago

Interesting - have a friend going through Prostate Cancer and all docs here in Singapore have suggested surgery + chemo. I noticed in Steve's shared PDF that Prostate Cancer has already crossed the FDA Approval and Reimbursement stage. Anyone had any personal experiences in using HIFU (high intensity focussed ultrasound)? Specifically the stage up to which it is effective over surgery+chemo My data sources: - https://cdn.fusfoundation.org/2023/02/06115144/Focused-Ultrasound-Foundation_State-of-the-Field-Report-2022_Jan-18.pdf#page=16 https://cdn.fusfoundation.org/2023/02/06115144/Focused-Ultra... - https://www.mayoclinic.org/medical-professionals/urology/news/high-intensity-focused-ultrasound-for-the-treatment-of-prostate-cancer/mqc-20519431 https://www.mayoclinic.org/medical-professionals/urology/new...

gadders 3y ago
You might find this podcast of interest. The guy talks about his experience of the TULSA procedure. They're kind of cynical about the state of prostate treatment in general but seem keen on this procedure. https://www.podchaser.com/podcasts/starting-strength-radio-9575/episodes/greg-ellifritz-cancer-treatmen-187310706 https://www.podchaser.com/podcasts/starting-strength-radio-9...

thrwyfrths 3y ago

I’ve always wondered what happened to Steve Jurvetson. He laid low for a while after resigning from the Tesla Board of Directors. I see he is active on Twitter/X now.

cinntaile 3y ago
Isn't every VC investor basically a "thought leader" on Twitter? I assume it helps with deal flow?
iancmceachern 3y ago
He had that whole issue with impropriety and sexual harassment at DFJ, that's what happened.

latchkey 3y ago

When I was a kid, I fell on my wrist. It healed up badly and formed a lot of calcium deposits around the bones. I couldn't bend my wrist backwards more than a couple degrees and it was painful. Went to a PT who used ultrasound treatments and stretching to break down the deposits, which freed my wrist up. This was in the 1980's.

whatshisface 3y ago
Dealing acoustically with something different from the surrounding material (calcium deposits) is a lot easier than focusing on tissues with roughly the acoustic properties of water among other tissues with the acoustic properties of water - in the former case the stuff can distinguish itself w.r.t. application of the waves, the latter requires focusing to come "from the outside."
tomek_ycomb 3y ago
Ultrasonics have been used for kidney stones for a while, too. But, this is something different as noted elsewhere

tommiegannert 3y ago

The gamma knife is a similar idea, but using gamma radiation focusing: https://www.mayoclinic.org/tests-procedures/brain-stereotactic-radiosurgery/about/pac-20384679#dialogId49199783 https://www.mayoclinic.org/tests-procedures/brain-stereotact... Edit: similar idea

izoow 3y ago

I remember randomly visiting a lecture of one of my professors that specializes in high performance computing, he was showing off the research they do and it was regarding computing the necessary "parameters" for this. Apparently calculating the parameters for a single patient to focus just the right spot and not damage anything is a task that takes several hours on a supercomputer. This might've been like 5 years ago.

glfharris 3y ago

Describing it as a best kept secret seems unnecessarily adversarial. The medical community aren't jealously guarding treatments from the populace. Arguably shock wave lithotripsy, a common method for breaking up kidney stones, could be described as focused ultrasound.

mmastrac 3y ago
I think it's a figure of speech meaning that it's just not widely known.
jhallenworld 3y ago
It seems they are considering it for kidney stones, perhaps in addition to lithotripsy: https://www.fusfoundation.org/diseases-and-conditions/kidney-stones/ https://www.fusfoundation.org/diseases-and-conditions/kidney... Lithotripsy is pretty limited, I think the preference in most cases is to use ureteroscopy (using holmium laser ablation to break up stones).. but as someone who's had this, I can tell you it's no fun- any progress would be welcome.

bobim 3y ago

Meh? It’s been on the French health market for at least two decades (Ablatherm). It’s effective for people that wouldn’t bear anesthesia but it comes with some limitations. It can’t be used when there are bones, lungs or non-uniform propagation medium in front of the target. And while the tissues are burnt their mechanical properties are evolving and deflecting the beam. The cavitation due to negative alternance of pressure waves puts a limit on the power. Perfusion can take the heat away, etc… It’s probably not widely used because conventional surgery is often more practical.

caycep 3y ago

From the brain side, those of us who remember the pallidotomy and thalamotomy days, the "noninvasive" part is a marketing misnomer. It's invasive (it's a lesioning/ablation therapy); it just doesn't require a pallidotomy. But it's a shockingly effective tactic; there's a steady stream of patients rolling in the office with mild symptoms who are willingly requesting to have a hole burned in their head. (Also it's turning out not to be nearly as effective in treating symptoms as deep brain stimulation)

caycep 3y ago
*edit "doesn't require a craniotomy" - the procedure is a thalamotomy.

aheilbut 3y ago

related practical application https://www.beckman.com/liquid-handlers/echo-acoustic-technology https://www.beckman.com/liquid-handlers/echo-acoustic-techno...

38 3y ago

non crap link: http://farside.link/twitter.com/FutureJurvetson/status/1708306322729607596 http://farside.link/twitter.com/FutureJurvetson/status/17083...

interfacer 3y ago

If you are interested in learning more about focused ultrasound there is a great python toolbox that allows you generate simulations, change parameters, visualize results, etc. https://agencyenterprise.github.io/neurotechdevkit/ https://agencyenterprise.github.io/neurotechdevkit/ From the repo “The Neurotech Development Kit (NDK) is an open-source, community-driven software library designed to lower the barrier of entry to the next generation of neurotechnology for current researchers and companies. It also enables software developers without access to hardware and human subjects to solve open problems in the field. The initial release of NDK provides support for transcranial focused ultrasound stimulation, along with comprehensive documentation, API flexibility, and 2D/3D visualizations. Future areas of interest may include photoacoustic and optical whole-brain imaging.”