Apparatus, system and method for evaluation of esophageal function

• US 20050124888A1
• Filed: 11/22/2004
• Published: 06/09/2005
• Est. Priority Date: 05/23/2002
• Status: Active Grant

• Current Assignee: Hadasit Medical Research Services & Development Ltd (Hadassah, The Women's Zionist Organization of America, Inc.)
• Original Assignee: Hadasit Medical Research Services & Development Ltd (Hadassah, The Women's Zionist Organization of America, Inc.)
• Inventors: Lysiansky, Michael, Jjt Rein, Azaria
• Granted Patent: US 7,604,598 B2
• Time in Patent Office: Days
• US Class Current: 600/443
• CPC Class Codes: A61B 8/0833 involving detecting or locating foreign bodies or organic structures
• CPC Class Codes: A61B 8/481 involving the use of contrast agent, e.g. microbubbles introduced into the bloodstream analysis of echo signal exploiting properties of a contrast enhancer in devices for short-range imaging with acoustic waves G01S7/52039

Abstract

A method, system and apparatus for ultrasonically imaging boli that are swallowed, as they are passed through the esophagus. The trajectories of the boli are tracked, and image data corresponding to the esophagus thereby identified. Analysis of boli and esophagus image data enable esophageal parameters correlated thereto to be determined.

Claims

1. A method for monitoring passage of at least one food bolus through the esophagus whereby to evaluate the esophageal function of a patient, comprising the steps:

(a) acquiring ultrasonic image data of said at least one bolus at a plurality of temporal intervals as said at least one bolus passes through the esophagus after being swallowed by the patient;

(b) tracking said at least one bolus in said image data to identify esophagus and bolus image data corresponding to said bolus and to said esophagus in said image data;

(c) determining at least one esophagus function parameter from the said bolus and esophagus image data.

3. A method as claimed in claim 1, wherein step (b) comprises the steps of:

(e) determining global motion of the esophagus in the image data acquired in step (a);

(f) aligning image data in consecutive image data by correcting for the global motion determined in step (e);

(g) identifying esophagus image data by first identifying the position of the bolus image in successive images corresponding to the bolus traversing the esophagus.

4. A method as claimed in claim 3, wherein step (e) is preceded by the step:

(d) choosing a region of interest in said image data acquired in step (a), wherein step (e) is performed on the region of interest image data.

5. A method as claimed in claim 4, wherein (e) is performed by determining the global motion of a reference zone of the image data at said plurality of temporal intervals.

6. A method as claimed in claim 5, wherein said reference zone is such that there is relatively insignificant relative movement between said reference zone and said esophagus in said image data.

7. A method according to claim 3, further comprising the step:

(h) projecting the identified esophagus image data in step (g) to a polygonal image matrix.

8. A method as claimed in claim 7, wherein said polygonal image matrix is in the form of a rectangle.

9. A method according to claim 7, wherein step (c) comprises the sub-steps:

(j) obtaining one-dimensional image data corresponding to a line of the esophagus data obtained in step (h) for each esophagus image data along said plurality of temporal intervals;

(k) constructing an M-mode representation of the data provided in step (j);

(l) identifying trajectories of boli in said M-mode representation and determining at least one esophagus parameter therefrom.

10. A method as claimed in claim 9, wherein in step (j), said line is the midline of said esophagus image data.

11. A method as claimed in claim 9, wherein said esophagus parameter is the velocity of said at least one bolus.

12. A method as claimed in claim 7, wherein step (c) comprises the sub-steps:

(m) choosing at least one station along one said esophagus image data frame;

(n) choosing at least one control zone at said at least one station;

(o) identifying a control zone in a subsequent esophagus image data frame having the closest image data to said at least one control zone of said station in (n);

(p) determining the displacement of the control zone in (n) and the identified control zone in (o);

(q) determining at least one esophagus parameter therefrom and/or from the time interval between said image data frame and said subsequent image data frame.

13. A method as claimed in claim 12, wherein said esophagus parameter is the velocity of said at least one bolus.

14. A method as claimed in claim 13, wherein another said esophagus parameter is the acceleration of said at least one bolus.

15. A method as claimed in claim 12, wherein step (o) is performed by means of minimizing the SAD between the image of the control zone in (n) and the image of the identified control zone in (o).

16. A method as claimed in claim 12, wherein steps (m) to (q) are performed for each consecutive pair of esophagus image frames along the time domain.

17. A method as claimed in claim 1, wherein in step (a) said image data also comprises dynamic data for each said temporal interval.

18. A method as claimed in claim 17, wherein said dynamic image data comprise Doppler velocity and is acquired by means of a Doppler technique.

19. A method as claimed in claim 17, wherein in step (b) bolus image data is identified by determining higher velocity regions of the image data.

20. A method as claimed in claim 19, wherein said high velocity regions are visualized using a suitable colour-coded tissue velocity imaging technique.

21. A method as claimed in claim 17, wherein step (c) is performed substantially in real-time.

22. A method as claimed in claim 17, wherein step (c) is performed in off-line.

23. A method as claimed in claim 17, wherein step (b) is carried out for a first portion of image motion data in (a) corresponding to an imaginary axis within said image motion data recorded at each said time interval to provide velocity data along said axis.

24. A method as claimed in claim 23, wherein said imaginary axis is substantially aligned with the longitudinal axis of the esophagus.

25. A method as claimed in claim 24 wherein said first portion of said image motion data corresponding to said imaginary axis is compiled from each consecutive image data obtained at consecutive time intervals in step (a), to provide velocity data along said axis as a function of time.

26. A method as claimed in claim 25, wherein the position and trajectory of a bolus along the said axis with respect to time is correlated to portions of said velocity data having the relatively higher magnitudes of velocity among said velocity data.

27. A method as claimed in claim 26, wherein average velocity of a bolus along said axis is determined by identifying the trajectory of the bolus in said velocity data and providing the quotient of:

(distance covered by the bolus along said axis) divided by (the corresponding time taken by the bolus).

28. A method as claimed in claim 27, wherein the position and trajectory of a number of consecutive boli along the said axis with respect to time is correlated to corresponding portions of said velocity data having the higher magnitudes of velocity among said velocity data.

29. A method as claimed in claim 28, wherein inter-bolus distance and or inter-boli time interval along said axis is determined by identifying the trajectory of two consecutive boli in said velocity data and providing the distance between the two trajectories at any particular time interval within these trajectories.

30. A method as claimed in claim 18, wherein step (b) is carried out for a second portion of image motion data in (a) corresponding to at least one predetermined location within said image motion data recorded at each said time interval to provide velocity data at said location.

31. A method as claimed in claim 30, wherein said at least one location is located substantially on the longitudinal axis of the esophagus.

32. A method as claimed in claim 31, wherein said second portion of said image motion data corresponding to said location is compiled from each consecutive image data obtained at consecutive time intervals in step (a) to provide velocity data at said location as a function of time.

33. A method as claimed in claim 32, wherein the direction and velocity of boli passing through said location with respect to time is correlated to portions of said velocity data having the relatively higher magnitudes of velocity among said velocity data.

34. A method as claimed in claim 33, wherein peak velocity of a bolus passing through said location is determined by identifying a corresponding velocity peak in said velocity data.

35. A method as claimed in claim 34 wherein the mode of propagation of a number of consecutive boli at said location with respect to time is correlated to the integral of the velocity data with respect to time.

36. A method as claimed in claim 35, wherein the mode of propagation of the esophagus is antegrade mode, retrograde mode and non-propulsive modes, according to whether the said integral is substantially positive, negative or zero, respectively.

37. A method as claimed in claim 17, wherein said ultrasonic image motion data in step (b) is procured using a suitable tissue velocity imaging technique.

38. A method as claimed in claim 1, wherein said at least one esophagus function parameter comprises at least one, preferably more than one and more preferably all of the following:

propagation direction, inter-boli time interval, inter-boli space interval, velocity and acceleration of peristaltic waves.

39. A method as claimed in claim 1, wherein said boli are liquid, and thus substantially incompressible, wherein the boli propagation, inter-bolus time interval, and velocity are particularly closely related to the equivalent peristaltic wave characteristics of the esophageal wall.

40. A comparative methods for assessing the effect of a predetermined factor on the esophageal function of a patient, comprising:

(i) evaluating the esophageal function of said patient according to claim 1, wherein said food bolus initially swallowed by the patient conforms to a first condition;

(ii) repeating step (i) with the same method, but wherein the food bolus is now swallowed by the patient conforming to a second condition;

(iii) comparing the results obtained between steps (i) and (ii).

41. A method as claimed in claim 40, particularly for assessing the effect of added medication on the esophageal function of a patient, comprising:

(i) evaluating the esophageal function of said patient according to the method defined in claim 1, wherein said food bolus of step (a) does not comprise said added medication;

(ii) repeating step (i), wherein the food bolus of step (a) now comprises said added medication;

(iii) comparing the results obtained between steps (i) and (ii).

42. A method as claimed in claim 41, wherein said added medication includes at least one anti reflux medication.

43. A method as claimed in claim 40, particularly for assessing the effect of particular foodstuffs on the esophageal function of a patient, comprising:

(i) evaluating the esophageal function of said patient according to claim 1, wherein said food bolus initially swallowed by the patient comprises a datum foodstuff;

(ii) repeating step (i) with the same method, but wherein the food bolus now swallowed by the patient replaced by a bolus of the foodstuff being investigated;

(iii) comparing the results obtained between steps (i) and (ii).

44. A method as claimed in claim 40, wherein the foodstuff being investigated includes a new milk formula or cereal.

45. A method as claimed in claim 40, particularly for assessing the effect of the position of the patient on the esophageal function of the patient, comprising:

(i) evaluating the esophageal function of said patient according to claim 1, wherein said food bolus is initially swallowed by the patient while in a first position;

(ii) repeating step (i) with the same method, but wherein the food bolus of preferably the same type of food is now swallowed by the patient while in a second position;

(iii) comparing the results obtained between steps (i) and (ii).

46. A method as claimed in claim 45, wherein said first position and said second position may include any one of sitting, lying down, standing, bending over, and the like.

47. A system for evaluating esophageal function of a patient, comprising an ultrasonic imaging system operatively connected to a suitable analysis unit, characterized in that the analysis unit is adapted for evaluating esophageal function as defined in claim 1.

48. A device for evaluating esophageal function of a patient, comprising an ultrasonic imaging means having a operatively connected to a suitable analysis means, characterized in that the analysis means is adapted for evaluating esophageal function as defined in claim 1.

2. A method for evaluating the esophageal function of a patient when the patient is in the process of swallowing at least one food bolus via the esophagus, comprises the steps:

(a) acquiring ultrasonic image data of at least one bolus at a plurality of temporal intervals as said at least one bolus passes through the esophagus;

(b) tracking said at least one bolus in said image data to identify esophagus and bolus image data corresponding to the bolus and to said esophagus in said image data;

(c) determining at least one esophagus function parameter from the said bolus and esophagus image data.