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Frustrated StudentWhether you are trying to earn your first ultrasound credential, or adding a specialization, we can all agree that there isn’t much fun in sitting for the examination.  The nature of the exam lends itself to anxiety, because it is ‘PASS/FAIL’.  There are no Gold, Silver or Bronze medals … nor is there even a Participation Trophy.  It is a binary result (Win-Lose), and 2nd Place is equivalent to a loss.

Modern cultural emphasis on raising/maintaining self-esteem has rendered the word ‘failure’ Continue reading

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New Paradigms for Ultrasound: Essential Tremor


I grew up in a household where ultrasound technology or sonography was as likely a dinner-table topic as our individual school day routines. Both my parents work in this field and would often use ultrasound systems for teaching. This past summer, I attended a summer program at Harvard during which I studied neuropsychiatry. When asked to create a capstone presentation on a topic that dealt with the brain, I immediately gravitated toward ultrasound, a subject that has fascinated me since I was a young child. The following commentary is taken from that assignment and exercise.

garfieldIt is largely taken for granted that the primary value of ultrasound technology is its ability to probe inner organs and tissues without the use of an invasive scalpel or surgical instrument. It is hard to believe the advancements we have seen within my parents’ lifetime, and disturbing to discover what passed for medical assessment in the late 1800s and early 1900s.


Research & Regulatory Approval by Indication (Red: FDA Approval, Orange: Outside USA Approval, Yellow: Pilot Trials)

Nowhere is the
potential for
ultrasound technology as an alternative to invasive procedure more promising than in the field of neuroscience specific to the human brain. Rather obviously, it is very difficult organ to access. This makes sense anatomically because it is a very important organ, and one would expect that Nature wished it to be protected.

karl-duffIronically, while early pioneering research, by Dr. Karl Dussik of Austria in 1942, is based on experiments assessing brain physiology, the medical fields most impacted by sonography over the next 40-50 years (OB/GYN, Abdomen, Breast) were not brain-related. It is only recently this technology has reached trial/approval status in neurobiological fields.

One neurological disorder that emerging ultrasound technology offers promise to relieve is Essential Tremor. It is among the most commonly observed tremor disorders, although distinct from Parkinson’s Disease. Several million Americans are estimated to be suffering from this disease. Prior to 2016, when the United States FDA approved a focused ultrasound device for treatment of this condition, patients’ only alternatives were anticonvulsant medications or brain surgery. The surgical options being a permanent removal of brain tissue (thalamotomy) or the implantation of an electronic device to periodically shock the thalamus (deep brain stimulation). Both these options are considered invasive.



Specifically, with respect to cranial anatomy, focused ultrasound’s ability to excise tissue without disturbing the integrity of the scalp and skull offers great hope to those cruelly afflicted by convulsive disorders. Previous blog posts have noted that the future promise for ultrasound treatment versus surgical intervention rests on its precision and non-invasive qualities. The potential applications are only beginning to be imagined.

In two weeks, I will follow up this discussion with the potentials being studied for the treatment of Alzheimer’s Disease with ultrasound technology.

Gina Miele is the daughter of Frank Miele, MSEE , President of Pegasus Lectures, Inc. and Carol Miele, RN, RVT, RDCS, FSVU, Vice President.  She attends high school in Dallas, Texas as a Junior at The Hockaday School.

*** A Special ‘Thank You‘ to Focused Ultrasound Foundation for use of images, statistical and industry research.

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New Paradigms for Ultrasound – Part II


Our previous blog opened a multi-part discussion on the expanding fields of ultrasound technology and potential applications in healthcare beyond interrogation and imaging for diagnostics.  This material is adapted and condensed from presentations given at SDMS Conventions and the AVID Symposium in 2017.  As stated previously, for those of you considering an entry into this profession, therapeutic ultrasound represents broader specialization possibilities, and wider opportunities for career advancement and success.

We noted with irony that many of the most exciting potential applications are based on utilizing properties of ultrasound that we have traditionally thought of as undesirable (i.e. Mechanical and Thermal Bioeffects). One of the more recent and promising fields of research involves harnessing the physical properties of ultrasound waves in service of more effective transdermal drug delivery, referred to as sonophoresis.  Transdermal drug delivery was popularized in the 1990’s most notably associating with the Nicoderm patch.  Today, for example, its application in the delivery of Fentanyl for treatment of chronic pain is well known.

thick-skinLimitations exist to the effectiveness of transdermal delivery that leave it a distant third option to oral delivery and the often-loathed subdermal injection.  Many of these relate to the non-uniform nature of different patients’ stratum corneum (the outer layer of the epidermis).  Basically some of us are more “thin-skinned” or “thick-skinned” physically, rather than metaphorically.

Ultrasound, as with all sound waves, has an underlying wave force.  Where researchers foresee promise is in using this wave force to “push” drug molecules through upper layers of the irregular epidermis to the subdermal layers where it can be absorbed.  Obviously, a needle does the same thing only by a more intrusive and painful means.

needleThis is potentially revolutionary if the technology advances to a point where it offers an alternative to the currently-prevalent subdermal needle injection by which most vaccines are delivered.  Many patients would be more amenable to vaccination, if needles were not required.  Additionally, needles represent an everyday biohazard in their disposal, and an infection source when the economically-disadvantaged are tempted to reuse them.  Additionally, this technologically can prove extremely beneficial when injections are required on a daily basis such as with insulin for diabetics.  Avoiding an occasional injection may be considered desirable, but avoiding repeated injections is significantly advantageous, especially if the transdermal approach can result in more effective control of blood glucose levels (as shown by this graph).


Another interesting field of study is advancing based on using the force of cavitation to drive localized drug delivery.  This is especially promising where it is desirable to deliver a drug targeted to an infinitesimal mass (cancerous tissue or tumor). Again, as you may recall,  because of the chaotic and intense energy (heat and pressure) associating with cavitation it is traditionally viewed as something to be controlled and minimized.  This is based on both its effect on the tissue (thermal and mechanical) and the impact on the ultrasound image.


herdingUntil recently, channeling cavitational force intentionally within a living body would have been viewed like fishing with sticks of dynamite.  However, because ultrasound force can now be delivered with more pin-point accuracy, this energy can be localized to activate drugs when in close proximity to a treatment site. Essentially, its power can be used to “herd” the drug toward its intended target, and/or activate it once there. By executing this reaction so precisely, the percentage of drug delivered to where it is actually needed can be enhanced to a point where it is more effective.

Frank Miele, MSEE , President of Pegasus Lectures, Inc.  Frank graduated cum laude from Dartmouth College with a triple major in physics, mathematics, and engineering. While at Dartmouth, he was a Proctor Scholar and received citations for academic excellence in comparative literature, atomic physics and quantum mechanics, and real analysis. Frank was a research and design engineer and project leader, designing ultrasound equipment and electronics for more than ten years at Hewlett Packard Company. As a designer of ultrasound, he has lectured across the country to sonographers, physicians, engineers and students on myriad topics.

*** A Special ‘Thank You‘ to Focused Ultrasound Foundation for use of images, statistical and industry research.

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