U.S. patent application number 17/423498 was filed with the patent office on 2022-04-14 for method of detecting an abnormality along a portion of a dental arch.
The applicant listed for this patent is CARESTREAM DENTAL LLC, TROPHY SAS. Invention is credited to Arnaud CAPRI, Jean-Marc INGLESE, Herve JOSSO, David ROUDERGUES, Edward SHELLARD.
Application Number | 20220110605 17/423498 |
Document ID | / |
Family ID | 1000006092039 |
Filed Date | 2022-04-14 |
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United States Patent
Application |
20220110605 |
Kind Code |
A1 |
CAPRI; Arnaud ; et
al. |
April 14, 2022 |
METHOD OF DETECTING AN ABNORMALITY ALONG A PORTION OF A DENTAL
ARCH
Abstract
At least one embodiment of a method for a method of detecting an
abnormality along a portion of a dental arch using scanning
material comprising an ultrasonic periodontal probe configured for
emitting ultrasound signals within at least one emitting cone and
for receiving corresponding echoed ultrasound signals, the method
comprising moving the probe along a portion of the dental arch,
while moving the probe along the portion of the dental arch:
emitting an ultrasound signal within the emitting cone; measuring
echoed ultrasound signals; detecting at least one anatomical
structure to be investigated; measuring at least one predetermined
feature of the at least one detected anatomical structure to obtain
a value of the measurement of the at least one predetermined
feature characterizing the detected anatomical structure; detecting
an abnormality as a function of a threshold and the value of the
measurement of the predetermined feature of the at least one
detected anatomical structure.
Inventors: |
CAPRI; Arnaud; (Marne La
Vallee, FR) ; ROUDERGUES; David; (Marne La Vallee,
FR) ; INGLESE; Jean-Marc; (Bussy-Saint-Georges,
FR) ; SHELLARD; Edward; (Atlanta, GA) ; JOSSO;
Herve; (Marne La Vallee, FR) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
TROPHY SAS
CARESTREAM DENTAL LLC |
Marne La Vallee Cedex 2
Atlanta |
GA |
FR
US |
|
|
Family ID: |
1000006092039 |
Appl. No.: |
17/423498 |
Filed: |
January 16, 2020 |
PCT Filed: |
January 16, 2020 |
PCT NO: |
PCT/EP2020/051062 |
371 Date: |
July 16, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
62793357 |
Jan 16, 2019 |
|
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|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61C 19/043 20130101;
A61B 8/0875 20130101; A61B 8/462 20130101; A61B 8/4254 20130101;
A61B 8/14 20130101; A61B 8/12 20130101 |
International
Class: |
A61B 8/08 20060101
A61B008/08; A61B 8/14 20060101 A61B008/14; A61C 19/04 20060101
A61C019/04; A61B 8/00 20060101 A61B008/00; A61B 8/12 20060101
A61B008/12 |
Claims
1. A method of detecting an abnormality along a portion of a dental
arch using scanning material comprising an ultrasonic periodontal
probe (300) configured for emitting ultrasound signals within at
least one emitting cone and for receiving corresponding echoed
ultrasound signals, the method comprising moving the probe (300)
along a portion of the dental arch (500, 505), while moving the
probe (300) along the portion of the dental arch (500, 505):
emitting an ultrasound signal within the emitting cone; measuring
echoed ultrasound signals; detecting at least one anatomical
structure to be investigated; measuring at least one predetermined
feature of the at least one detected anatomical structure to obtain
a value of the measurement of the at least one predetermined
feature characterizing the detected anatomical structure; detecting
an abnormality as a function of a threshold and the value of the
measurement of the predetermined feature of the at least one
detected anatomical structure.
2. The method according to claim 1, wherein detecting at least one
anatomical structure to be investigated comprises: building images
continuously based on the measured echoed signals; analyzing the
built images in order to detect at least one anatomical
structure.
3. The method according to claim 1 or 2, the physical quantity
relating to the at least one detected anatomical structure is one
of a dimension, an echogenicity indicator, a texture inhomogeneity,
a texture complexity.
4. The method according to claim 2, wherein analyzing the built
images comprises segmenting the built images for detecting at least
one anatomical structure in the built images.
5. The method according to any one claims 1 to 4, wherein the at
least one anatomical structure comprises alone or in combination a
tooth and/or a gum and/or a periodontal pocket and/or a cortical
bone.
6. The method according to claim 5, wherein the physical quantity
relating to a detected periodontal pocket is a dimension such as
depth.
7. The method according to claims 1 to 6, wherein each measurement
is notified to the operator while moving the probe (300) along the
portion of the dental arch (500, 505).
8. The method according to claims 1 to 7, wherein a maximal
measurement value and/or a minimal measurement value is notified to
the operator while moving the probe (300) along the portion of the
dental arch (500, 505).
9. The method according to any one of claims 1 to 8, wherein
emitting an ultrasound signal comprises recording an angulation of
the probe (300) and/or recording the position of the probe
(300).
10. The method according to any one of claims 1 to 9, wherein the
ultrasonic periodontal probe (300) is configured for emitting
ultrasound signals within at least one of several emitting cones
extending in different directions.
11. The method according to claim 10, wherein emitting an
ultrasound signal comprises selecting at least one of the several
emitting cones and emitting an ultrasound signal within the at
least one selected emitting cone.
12. The method according to any one of claims 1 to 11, wherein the
probe comprises at least an indicator configured to provide an item
of information regarding an identified abnormality, and wherein the
method further comprises: energizing the indicator to indicate a
detected abnormality.
13. The method according to claim 12, wherein the indicator
comprises one or more light emitting devices (330) and/or LCD
screen and/or vibration means and/or sound effects.
Description
FIELD OF THE INVENTION
[0001] The present invention relates to the technical field of
ultrasonic probes and of ultrasonic dental probes for screening a
region of interest, such as a periodontium or a gingiva area of a
patient mouth.
BACKGROUND OF THE INVENTION
[0002] Ultrasound imaging has been adapted for intraoral use in a
number of implementations and has been found to have particular
utility for tasks such as measurement of periodontal pocket depth.
Periodontal diseases such as gingivitis, for example, can be
detected by sensing the acoustic response of tissues. Ultrasound
may also provide accurate information about the pathological nature
of lesions.
[0003] By comparison with conventional methods used for periodontal
pocket evaluation, ultrasound probing is relatively more
comfortable and can be more accurate. Because it uses only
ultrasound signals, ultrasound probing is inherently safer than
methods that employ ionizing radiation. Ultrasound imaging can be
used as a substitute for, or a complement to, various types of
radiography (cone beam computed tomography or CBCT, panoramic
x-ray, or intraoral x-ray imaging), magnetic resonance imaging
(MRI), or nuclear medicine.
[0004] In order to observe structures, the ultrasound imaging may
use high frequency soundwaves between 1 to 100 MHz. High frequency
soundwaves may preferably be between 20 to 50 MHz for periodontal
pocket investigation.
[0005] An ultrasound imaging apparatus generally comprises one or
several transducers that act as ultrasound beam emitters and/or
ultrasound beam receivers to receive echoes from the emitted
signals. In addition, the ultrasound imaging apparatus may comprise
various processing and display components used for generating and
presenting images from acquired signals. An ultrasound beam emitter
generates an ultrasound signal from an electrical signal and
conversely, an ultrasound receiver generates electrical pulses from
a mechanical ultrasound signal.
[0006] Objects in the path of emitted ultrasound signals return a
portion of the ultrasound energy back to the transducer which
generates electrical signals indicative of the detected structures.
The electrical signals generated from the received ultrasound
signal can be delayed for selected times specific to each
transducer, so that ultrasonic energy scattered from selected
regions adds coherently, while ultrasonic energy from other regions
has no perceptible impact. Further, the emission of ultrasound
signals can be delayed in order to enable adaptive focusing. The
electronic adaptive focusing makes it possible to increase the
resolution depending on the depth of the imaged organ.
[0007] Array processing techniques used for generating and
processing received signals in this way are termed
"beamforming".
[0008] Particular challenges with intraoral ultrasound imaging
relate to the design of a probe that can be used for imaging a full
set of intraoral structures, i.e. during periodontal examination,
for positioning an ultrasound fan beam along the vertical axis of
each tooth of a mouth on both buccal and lingual faces, without the
need for extensive modification, reconfiguration, or changing of
probe tips or other components. Indeed, to be efficient, the
ultrasound probe window must be facing the regions to be imaged.
The acoustic paths between the transducer and the regions to be
imaged are ensured via coupling materials such as water-based gel
with minimal attenuation.
[0009] Periodontal check-ups or screening exams consist in
measuring existing periodontal pockets to track periodontal
diseases. FIG. 1 illustrates an example of a dental structure 100
comprising a periodontal pocket 105. The teeth 110 are calcified
structure having a crown surface covered with enamel 115 and roots
attached to the bones of the superior or inferior jaws. Each tooth
110 is surrounded and supported by the periodontium, maintaining
them in the maxillary and mandibular bones.
[0010] The periodontium comprises gingiva (gum) 125, surrounding
the teeth 110 and providing a seal around them. The periodontium
also comprises the periodontal ligament (not illustrated), the
cementum (calcified substance covering the root of a tooth, not
illustrated) and an alveolar bone proper (portion of bone on the
jaws, maxilla and mandible, containing tooth sockets). The
cementoenamel junction (CEJ) 130 is the anatomical border between
the enamel 115 covering the crown of the tooth and the cementum
covering the roots of the tooth 110. The CEJ 130 is also usually
the area where the gingiva 125 attached to a healthy tooth by the
gingival fibres.
[0011] A potential abnormality of the periodontium is the
development of a periodontal pocket 105, meaning a space between
the gingiva 125 and the tooth 110. The pocket 105 is characterized
by a pocket base 170 and a cementoenamel junction (CEJ) 130, as
illustrated in FIG. 1. The pocket depth is the distance 140 between
the pocket base 170 and the cementoenamel junction (CEJ) 130. When
the top of gum 145 is vertically above the position of the CEJ 130,
the distance 140 is not detectable by the standard periodontal
probing and only the distance 135 is measurable and therefore
considered as the pocket depth. At the base 170 of the periodontal
pocket 105, the gingiva 125 is attached to the tooth 110 and forms
the bottom of the periodontal pocket.
[0012] In order to measure the depth 135, 140 of a periodontal
pocket 105, a periodontal probe may be used and inserted (as
indicated by arrow 150), at least partly, inside the periodontal
pocket 105, along the tooth 110. Ideally, it may be relevant to
detect the CEJ 130 under the gum (fixed reference), as the distance
140 (attachment level) is the most relevant to quantify the pocket
depth evolution. As illustrated in FIG. 2, in order to correctly
assess the periodontal pocket depth 135 of a given tooth 110, the
periodontal pocket 105 of one tooth 110 should be measured at
several locations, for example six locations, on the periphery of
the assessed tooth. In other words, using current probing systems
(such as manual probe 160 as illustrated) in order to correctly
examine the periodontal pockets 105 for a given tooth 110,
different positions 155a, 155b, 155c, 155d, 155e, 155f (e.g. six)
need to be checked for a single tooth 110.
[0013] Periodontal pockets 105 need to be regularly performed in
order to check any infection of the gingiva 125. Further
periodontal assessments may be accompanied with the measurement of
the gingival regression 165 between the CEJ 130 and the top of the
gum 145 (illustrated in FIG. 1).
[0014] For a young adult with no periodontal predispositions,
either the dentist chooses to perform a full periodontal
examination, which is time-consuming and often involves at least
two operators, or a partial periodontal examination with the risk
of missing periodontal issues near the unexamined teeth.
[0015] Other abnormalities can develop in the periodontium or the
gingiva area of the patients, such as tumours and/or abscesses.
Currently, the dentist may detect such abnormalities either by
observing the periodontium to the naked eye, or by biopsy. However,
such methods are time consuming, and do not allows an almost
immediate detection of abnormalities. The invention is directed to
overcoming these drawbacks. The technical solution provided
simplifies and speeds up periodontal screening examinations or
regular periodontal or gingiva check-ups.
SUMMARY OF THE INVENTION
[0016] The present invention has been devised to address one or
more of the foregoing concerns.
[0017] In this context, there is provided a method of detecting an
abnormality along a portion of a dental arch using scanning
material comprising an ultrasonic periodontal probe configured for
emitting ultrasound signals within at least one emitting cone and
for receiving corresponding echoed ultrasound signals, the method
comprising [0018] moving the probe along a portion of the dental
arch, while moving the probe along the portion of the dental arch:
[0019] emitting an ultrasound signal within the emitting cone;
[0020] measuring echoed ultrasound signals; [0021] detecting at
least one anatomical structure to be investigated; [0022] measuring
at least one predetermined feature of the at least one detected
anatomical structure to obtain a value of the measurement of the at
least one predetermined feature characterizing the detected
anatomical structure; [0023] detecting an abnormality as a function
of a threshold and the value of the measurement of the
predetermined feature of the at least one detected anatomical
structure.
[0024] Such a method enables the detection of abnormalities of the
periodontium and/or the gingiva, using an ultrasonic periodontal
probe during a fast scan of the patient gingiva or periodontium.
Thus, the method helps to simplifies and speed-up periodontal
examination, and also enables to detect abnormalities such as
tumors. Therefore, during the same examination it may be possible
to detect abnormalities of different natures.
[0025] According to some embodiments, detecting at least one
anatomical structure to be investigated may comprise: [0026]
building images continuously based on the measured echoed signals;
[0027] analyzing the built images in order to detect at least one
anatomical structure.
[0028] According to some embodiments, the physical quantity
relating to the at least one detected anatomical structure may be
one of a dimension, an echogenicity indicator, a texture
inhomogeneity, a texture complexity.
[0029] According to some embodiments, analyzing the built images
may comprise segmenting the built images for detecting at least one
anatomical structure in the built images.
[0030] According to some embodiments, the at least one anatomical
structure may comprise alone or in combination a tooth and/or a gum
and/or a periodontal pocket and/or a cortical bone.
[0031] According to some embodiments, the physical quantity
relating to a detected periodontal pocket may be a dimension such
as depth.
[0032] According to some embodiments, each measurement may be
notified to the operator while moving the probe along the portion
of the dental arch.
[0033] According to some embodiments, a maximal measurement value
and/or a minimal measurement value may be notified to the operator
while moving the probe along the portion of the dental arch.
[0034] According to some embodiments, emitting an ultrasound signal
may comprise recording an angulation of the probe and/or recording
the position of the probe.
[0035] According to some embodiments, the ultrasonic periodontal
probe may be configured for emitting ultrasound signals within at
least one of several emitting cones extending in different
directions.
[0036] According to some embodiments, emitting an ultrasound signal
may comprise selecting at least one of the several emitting cones
and emitting an ultrasound signal within the at least one selected
emitting cone.
[0037] According to some embodiments, the probe may comprise at
least an indicator configured to provide an item of information
regarding an identified abnormality, and wherein the method further
comprises: [0038] energizing the indicator to indicate a detected
abnormality.
[0039] According to some embodiments, the indicator may comprise
one or more light emitting devices and/or LCD screen and/or
vibration means and/or sound effects.
BRIEF DESCRIPTION OF THE DRAWINGS
[0040] Other features and advantages of the invention will become
apparent from the following description of non-limiting exemplary
embodiments, with reference to the appended drawings, in which:
[0041] FIG. 1 is an example of a dental structure comprising a
periodontal pocket;
[0042] FIG. 2 is an example of locations for assessing a
periodontal pocket according to prior art;
[0043] FIGS. 3a to 3c are examples of use of an ultrasonic imaging
probe according to some embodiments of the invention;
[0044] FIG. 4 is a schematic diagram illustrating an example of an
electronic system of an ultrasonic imaging probe;
[0045] FIGS. 5a and 5b are examples of the movement of a probe in
order to perform a screening of the periodontium; and
[0046] FIGS. 6 and 7 are examples of a protocol for screening
periodontal pockets; and
[0047] FIG. 8 is a diagram of an example of the method of scanning
material in order to detect an abnormality along a portion of a
dental arch according to some embodiments of the invention.
DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION
[0048] Some embodiments of the invention aim at providing a method
using an ultrasonic probe for screening a periodontium and/or
gingiva, for example for the development of periodontal pockets
and/or tumoral masses follow-ups. The method according to the
invention aims at performing a quick scan of the region of
interest, computing and registering in real time a predetermined
feature of an abnormality of a detected anatomical structure. The
scan may be performed on an arch or a quadrant. For example, in the
case of the periodontal pocket investigation in the periodontium,
thanks to the scan, it may be possible to obtain the maximum value
of the depth of a periodontal pocket in the assessed area. In that
example, the scan is easily performed by an operator given that the
probe movement is along the dental arch curve to the level of the
periodontal area, and not along the gum line.
[0049] The following is a detailed description of particular
embodiments of the invention, reference being made to the drawings
in which the same reference numerals identify the same elements of
structure in each of the Figures.
[0050] In the drawings and text that follow, like components are
designated with like reference numerals, and similar descriptions
concerning components and an arrangement or interaction of
components already described are omitted. Where they are used, the
terms "first", "second", and so on, do not necessarily denote any
ordinal or priority relation, but may simply be used to more
clearly distinguish one element from another, unless specified
otherwise.
[0051] When referring to the shape of an apparatus, the term
"rigid" should be understood as the substantially non-deformable
nature of the apparatus, in normal use, which means that the
relative position of main elements of the apparatus is
substantially constant (i.e. there is no significant shape
deformation during use). For example, the relative position of a
grip portion, of a support member, and of an ultrasonic device of a
rigid ultrasonic imaging probe is substantially constant when the
imaging probe is used for imaging intraoral structures. This does
not prevent the apparatus from being deformable during a
configuration step, for example in a case in which two elements of
the apparatus are fastened with a lockable hinge. In addition, this
does not prevent the apparatus from comprising slightly deformable
parts. For example, the grip portion of a rigid ultrasonic imaging
probe may comprise a deformable handgrip such as a handgrip
comprising elastic foam.
[0052] In the context of the present disclosure, the terms
"viewer", "operator", and "user" are considered to be equivalent
and refer to the viewing practitioner, technician, or other person
who acquires, views, and manipulates an ultrasound image, such as a
dental image, on a display monitor. An "operator instruction,"
"user instruction," or "viewer instruction" is obtained from
explicit commands entered by the viewer, such as by clicking a
button on the ultrasound probe or system hardware or by using a
computer mouse or by using a touch screen or a keyboard entry.
[0053] In the context of the present disclosure, the phrase "in
signal communication" indicates that two or more devices and/or
components are capable of communicating with each other via signals
that travel over some type of signal path. Signal communication may
be wired or wireless. The signals may be communication, power,
data, or energy signals. The signal paths may include physical,
electrical, magnetic, electromagnetic, optical, wired, and/or
wireless connections between the first device and/or component and
second device and/or component. The signal paths may also include
additional devices and/or components between the first device
and/or component and second device and/or component.
[0054] The term "subject" refers to the tooth or other portion of a
patient that is being imaged and, in optical terms, can be
considered equivalent to the "object" of the corresponding imaging
system.
[0055] Periodontal Probe
[0056] FIGS. 3a, 3b and 3c are schematic representations of a rigid
ultrasonic imaging probe that may be used in conjunction with
particular embodiments of the method of the invention. FIG. 3a is a
side view of the rigid ultrasonic imaging probe in a measurement
configuration while FIGS. 3b and 3c represent a top view and a
front view, respectively, of the same rigid ultrasonic imaging
probe in the initial configuration. For the sake of the
explanation, the initial configuration is distinguished from other
measurement configurations, but it is not excluded that
measurements are performed with the probe in the initial
position.
[0057] The probe provides the ultrasound pulse signal emission
and/or mechanical components for generating ultrasound beams in an
emitting cone. The ultrasound beams may be cone-shaped beams or a
fan-shaped beams contained in the emitting cone. The cone-shaped
ultrasound beams may correspond to the emitting cone or be smaller
than the emitting cone. Fan-shaped beams are planar.
[0058] The probe also provides acquisition logic for beamforming
functions. The probe or a remote computer (not represented) obtains
acquired signal data corresponding to received pulse echoes,
processed or not, and renders images of the examined objects on a
display that may be the LCD display of the probe or the remote
computer display. The image content can also be stored for
subsequent use or transmitted to another system or to a data
storage apparatus.
[0059] As illustrated, the ultrasonic imaging probe 300 comprises a
grip portion 305, a support member 310, and an ultrasonic device
315 (also referred to as ultrasonic sensor). According to the
illustrated example, support member 310 comprises two main parts
denoted 310-1 and 310-2, the longitudinal axis of part 310-2 being
different from the longitudinal axis of the grip portion 305. It is
to be noted that according to other examples, part 310-2 is
fastened directly to grip portion 305 (i.e. without using part
310-1). Therefore, according to the illustrated example, ultrasonic
device 315 is rigidly fastened to grip portion 305 in such a way
that it is offset from the grip portion with regard to its
longitudinal axis. As apparent from FIG. 3a, ultrasonic device 315
is located at a distance d from the longitudinal axis (a) of grip
portion 305. Distance d may be chosen between 0 and 5 centimeters.
For the sake of illustration, it may be equal to 2 centimeters.
Distance D between ultrasonic device 315 and grip portion 305 may
be chosen between 4 and 25 centimeters. For the sake of
illustration, it can be equal to 10 centimeters.
[0060] According to particular embodiments, support member 310 may
comprise two tubular members forming an angle .delta. between their
longitudinal axes, may comprise one or more tubular members and a
portion of an annular member, or may comprise any composition of
members making it possible to axially offset the ultrasonic device
from the grip portion.
[0061] As illustrated, grip portion 305 may comprise elements
enabling a user to interface with functions of ultrasonic imaging
probe 300 and/or with a computer system processing signals acquired
by ultrasonic imaging probe 300. Such elements may comprise
displays generically referenced 320 (e.g. standard displays or
touch screens) and buttons generically referenced 325. According to
particular embodiments, all these elements or a subset of these
elements may be duplicated (320-1/320-2 and 325-1/325-2) so that a
user may interact similarly with ultrasonic imaging probe 300
and/or with a computer system processing signals acquired by
ultrasonic imaging probe 300 whatever the position of the
ultrasonic imaging probe 300 between a first and a second position
(the second position being located on the opposite side of a
horizontal plane relative to the first position).
[0062] In addition, grip portion 305 may comprise a set of LEDs
(acronym of light emitting devices), for example the ring of LEDs
330. As described hereafter, these LEDs may be indicative of a
selected emitting cone.
[0063] According to some embodiments, the LEDs or the ring of LEDs
is arranged on the ultrasonic device or on the support member,
close to the ultrasonic sensor.
[0064] As illustrated in FIG. 3b, ultrasonic device 315 may be
configured to make measurements according to two opposite
directions, with reference to a vertical plane that is
perpendicular to a horizontal plane comprising the longitudinal
axis (a) of grip portion 305. Ultrasound fan beams may belong to
emitting cones having angular cones .alpha..sub.1 and .alpha..sub.2
and angular cones .beta..sub.1 and .beta..sub.2, as illustrated in
FIG. 3b and FIG. 3c, that may be in a range of 20.degree. to
160.degree.. Hereinafter, the expression "emitting cone" relates to
the two angular cones constituting the emitting cones as described
hereinbefore.
[0065] The transducers of the ultrasonic imaging probe 300 may be
of the A-mode, B-mode (or 2D mode), C-mode, M-mode, Doppler mode,
Color Doppler mode, Continuous Doppler mode, Pulsed wave Doppler
mode, Duplex mode, Pulse inversion mode, or Harmonic mode type,
each of them being well-known to the one skilled in the art.
[0066] According to some embodiments, each emitting cone is
associated to a given transducer.
[0067] According to particular embodiments, the ultrasonic imaging
probe 300 comprises a single transducer with a moving element (e.g.
a moving transducer and/or a moving reflector), two or more
transducers, or two or more arrays of transducers, arranged around
an axis of the ultrasonic device that is parallel to the
longitudinal axis of the grip portion, at least on each side of the
ultrasonic device (when considering a measurement position of the
probe 300). Thus, each position of the moving element (the
transducer or the reflector) is associated to an emitting cone. In
general, the moving element is rotatably mounted within a cavity of
the ultrasonic device 315. The moving element is characterized by
its acquisition scan direction that is the rotating direction of
the moving element. The acquisition scan direction defines the
orientation of the obtained images.
[0068] The transducers can act like an ultrasound beam emitter but
also as an ultrasound beam receiver, configured to measure echoed
ultrasound. Throughout the rest of the document, the transducers
are both ultrasound beam emitters and receivers. In another
embodiment, it may be considered that some transducers only act as
ultrasound beam emitter or ultrasound beam receiver.
[0069] When acting as an emitter, the transducer is associated with
an emitting cone that defines the volume, in which the associated
transducer is able to emit an ultrasound signal.
[0070] When acting as a receiver, the transducer is passive and is
configured to act as a sensor and to detect and measure any
received echoed ultrasound signals. In other words, the transducer
detects and measures the incidents waves.
[0071] According to some embodiments, each transducer may comprise
several emitting elements and/or several receiving elements. Having
several receiving elements, helps improving ultrasound beam
reception while reducing the effect of noise on the received
ultrasound signals.
[0072] It is noted that although the directions of the two emitting
cones (i.e. the cones in which ultrasound fan beams may be emitted)
represented in FIGS. 3b and 3c are perpendicular to the
longitudinal axis of grip portion 305 and to a vertical plane,
these directions may be different. These directions may form angles
.theta..sub.1 and .theta..sub.2 with regard to the longitudinal
axis of grip portion 305 and angles .gamma..sub.1 and .gamma..sub.2
with regard to a vertical axis perpendicular to the longitudinal
axis of grip portion 305, respectively, varying from about
20.degree. to 160.degree., provided that these directions are
opposite to each other, respectively, with regard to a plane
comprising the longitudinal axis of grip portion 305.
[0073] According to some embodiments, the probe may be configured
for emitting ultrasound signals within one emitting cone.
Consequently, the ultrasound signal is emitted along one direction,
which is comprised into the one emitting cone of the ultrasonic
device 315.
[0074] Electronic Elements of the Ultrasonic Imaging Probe
[0075] FIG. 4 is a schematic diagram illustrating an example of an
electronic system of an ultrasonic imaging probe 300.
[0076] As illustrated, the electronic system 400 comprises buses
and/or electrical connections connecting: [0077] a microcontroller
405; [0078] a random access memory 410, denoted RAM, for storing
the executable code for operating the ultrasonic imaging probe 300
as well as the registers adapted to record variables and
parameters; [0079] a read-only memory 415, denoted ROM, for storing
computer programs for operating the ultrasonic imaging probe 300
and/or configuration parameters; [0080] an input/output interface
420 to set the ultrasonic imaging probe 300 in signal communication
with a remote computer, for interfacing the ultrasonic imaging
probe 300 with the remote computer, for example to transmit
measured signals and/or receiving commands for controlling some of
the operations of the ultrasonic imaging probe 300, the
input/output interface being a wired or wireless interface, for
example a wireless interface complying with the WiFi and/or
Bluetooth standards (WiFi and Bluetooth are trademarks); [0081] a
display and/or LEDs 425 for giving indications to the user, for
example the state of the ultrasonic imaging probe 300, a step or a
next step to do, and/or the direction according to which
measurements are made or will be made, or the measurement value, or
whether one measurement value is greater than the threshold; [0082]
a motion sensor, a position sensor, and/or an orientation sensor
430 comprising, for example, an accelerometer and a gyroscope,
making it possible to determine the position, the orientation, the
speed, and/or the acceleration of the ultrasonic imaging probe 300,
which may be used, for example, to identify commands by gesture
type (e.g. a particular gesture may be used to select the
directions according to which measurements are to be made); [0083]
an ultrasonic device 435 comprising one or more transducers or
arrays of transducers as described above; [0084] a motor 440 for
moving parts of the ultrasonic sensor, for example a transducer, an
array of transducers, or a reflecting element; [0085] a battery
445, rechargeable or not, for providing electrical power to the
components of the electronic system; [0086] one or several
tachometers 450, for indicating for example the current value
and/or the maximum measurement and/or the minimum measurement, such
as a measured depth of a periodontal pocket and/or the measured
dimension and/or the texture complexity and/or the texture
inhomogeneity of the tumoral mass; and [0087] a loudspeaker 455,
for indicating the detection of an abnormality along the screened
portion.
[0088] It is to be noted that the ultrasound imaging device may
comprise other electronic elements such that some of the electronic
components mentioned above may not be required. For example, a
motor is not required if the ultrasonic imaging probe 300 comprises
several fixed transducers or arrays of transducers. Likewise,
internal electrical power may not be required if the ultrasonic
imaging probe 300 is connected to a remote computer via wires.
[0089] According to some embodiments, the executable code may be
stored either in read-only memory 415 or on a removable digital
medium such as for example a micro memory card. According to a
variant, the executable code of the programs can be received from
the remote computer via the input/output interface, in order to be
stored in one of the storage means of the communication device
400.
[0090] Microcontroller 405 is adapted to control and direct the
execution of the instructions or portions of software code of the
program or programs for operating the ultrasonic imaging probe 300
according to particular embodiments of the invention, the
instructions being stored in one of the aforementioned storage
means. After powering on, microcontroller 405 is capable of
executing instructions from main RAM memory 410 relating to a
software application after those instructions have been loaded from
ROM 415 or from a remote computer for example.
[0091] Microcontroller 405, RAM 410, and/or ROM 415 may be
implemented in hardware by a machine or a dedicated component, such
as an FPGA (Field-Programmable Gate Array) or an ASIC
(Application-Specific Integrated Circuit).
[0092] Upon reception, the acquired ultrasound signals may be
processed, for example filtered, by electronic system 400, for
example by microcontroller 405, before being transmitted to the
remote computer through input/output interface 420. According to
particular embodiments, the acquired ultrasound signals may be
processed to generate images that are transmitted to the remote
computer. Alternatively, the acquired ultrasound signals may be
transmitted directly to the remote computer as raw data. The
processing power and capabilities of electronic system 400 may
depend on the processing to be applied to the acquired ultrasound
signals.
[0093] The motion sensor and/or orientation sensor may be used to
detect predetermined commands. For example, a movement of the
ultrasonic imaging probe 300 to the right may indicate that
measurements are to be made on the right side of the ultrasonic
imaging probe 300. Likewise, a movement of the ultrasonic imaging
probe 300 to the left may indicate that measurements are to be made
on the left side of the ultrasonic imaging probe 300.
[0094] The motion sensor and/or orientation sensor may also be used
to determine the position of the ultrasonic imaging probe 300 with
regard to a default position. The determined position of the
ultrasonic imaging probe 300 may be used to appropriately orient
images generated from received ultrasound signals.
[0095] As described above, an indication may be displayed on a
display or as a subset of one or more LEDs to provide an indication
regarding the direction according to which measurements are made.
According to some embodiments, piezoelectric elements surrounding
the reception area are used to generate energy for energizing local
indicators (for example small LEDs) in the vicinity of the probe
tip 315.
[0096] To that end, piezoelectric elements, such as those used in
transducers, having the capability to both generate a mechanical
wave due to electrical excitation and, conversely, to generate an
electrical pulse once placed under mechanical stress, are used.
When using the ultrasonic imaging probe 300, a transducer generates
a number of ultrasound waves that are reflected and deviated by the
observed tissues. During signal acquisition, for generating images,
incident waves not only impact the transducer but also affect areas
outside the transducer surface, including portions of the
piezoelectric material not used for capturing signals, called
piezoelectric wells for the sake of clarity. Therefore, it is
possible to use part of the excess energy that is otherwise lost,
in the vicinity of the emitters and receivers actually used to make
measurements, by considering a number of piezoelectric sources for
energy harvesting. These piezoelectric wells can capture excess
energy that is not captured as part of the reflected acoustic
signal and generate sufficient current to energize small LEDs and
associated capacitive elements. As described above, the generated
illumination from this energy harvesting can provide information to
the user, to visually highlight the position or angular orientation
of the emitted ultrasound beam. The generated illumination may even
be strong enough to illuminate the scanned area.
[0097] According to some embodiments, the probe may be autonomous.
In other words, the probe may be usable without any other systems,
such as a remote computer. In this case, the probe may be
configured to emit ultrasound signals, to acquire echoed ultrasound
signals, to build an ultrasound image, to perform measurements and
then to display notifications on the LCD display of the ultrasound
probe. Consequently, the probe may comprise a microcontroller
associated to memory (such as RAM and ROM) configured to process
the acquired echoed ultrasound signals. Thus the microcontroller of
the probe is configured to execute the instructions of the software
application recorded the embedded memory of the probe. Such a probe
is then autonomous for the reconstruction of the ultrasound images,
measurement of the echoed ultrasounds and notification of the
measurements and/or the reconstruction to the operator.
[0098] Initialization and Positioning of the Probe for Screening a
Region of Interest
[0099] FIGS. 5a and 5b illustrate examples of uses of an ultrasonic
imaging probe according to particular embodiments of the invention,
in order to screen a portion of the dental arch comprising soft and
hard tissues.
[0100] FIG. 5a illustrate the movement of the probe 300, when it is
used to screen a region of interest in a patient mouth. The
operator handles the grip portion 305 of the probe 300 and arranges
the ultrasonic device 315 of the probe 300 in order to observe the
region of interest.
[0101] An example of an area of interest for detecting
abnormalities is the gingiva area 515, indicated in FIG. 5a. The
gingiva area 515 can be defined as the visible part covering the
periodontia. This area also corresponds to a sector of the mouth in
which the periodontal pockets are likely to develop. As explained
hereinbefore in reference to FIG. 1, a periodontal pocket 105 may
appear between the tooth 110 and the gum 125 in the circumferential
area of the tooth 110 where the gum 125 usually surrounds the tooth
110 in collar-like fashion. The gingiva area 515 is a sector
extending along both dental arch 500, 505. The dental arches 500,
505 are the two arches that contain teeth 110, one of each jaw,
that constitute together the dentition 510. The upper dental arch
505 of the maxilla (or upper jaw) and the lower dental arch 500 of
the mandible (or lower jaw) respectively comprises periodontia
which maintain the teeth on the maxilla and the mandible.
[0102] The same gingiva area also corresponds to a sector of the
mouth in which tumoral masses are likely to develop. Indeed, the
tumoral masses may appear in the gingiva epitheliums. A tumoral
mass may be detected using the ultrasound probe when moved along
this area. Indeed, the detection of a change in the echogenicity
response of the raw echoed ultrasound signals or a specific mass
visible in the reconstructed image may allow a tumoral mass to be
detected.
[0103] As visible in FIG. 5a, each dental arch 500, 505 is an arc,
i.e. having a curve
[0104] In order to observe a portion of the gingiva area 515, the
ultrasonic device 315 is arranged such that the cone-shaped or
fan-shaped beam emitted within the emitting cone is reflected on
the portion of the area of interest to be observed.
[0105] To do so, the ultrasonic device 315 may be arranged such
that the portion of the area of interest is contained in the
emitting cones and/or is intersected by a plane of the emitting
cones containing the fan-beam, further explained in relation with
FIG. 5b.
[0106] Moreover, as the gingiva area 515 extends along the dental
arch 500, 505, in order to have a comprehensive investigation of
the gingiva area 515, the operator may put in motion the ultrasonic
device 315 in order to obtain several ultrasonic signals and/or
reconstructed images along the dental arches 500, 505.
[0107] In other words, when holding the probe 300, the operator
moves the probe 300 along a portion of the gingiva area 515 to be
observed.
[0108] An example of the movement of the probe for obtaining images
of the lower gingiva area of the mandibula is illustrated in FIG.
5a, by the arrow 520. As visible in FIG. 5a, the ultrasonic device
315 is arranged such that a transducer 525 faces the gingiva area
515 and is put in motion along the dental arch following arrow
520.
[0109] FIG. 5b illustrates the positioning of the ultrasonic device
315 of the probe 300 in order to measure anatomical structures of
the gingiva area 515, along the dental arches 500, 505.
[0110] During the acquisition process, in order to ensure that the
measurements of anatomical structures are correctly performed, the
probe 300, particularly the emitting cone of the probe 300, is
positioned in relation with the dental arch 500, 505 where the
gingiva area 515 to be observed is.
[0111] To do so, as visible of FIG. 5b, the angular position of the
probe 300, according to the tooth axis 535, could be monitored.
Thus, to obtain correct measurements of the given periodontal
pocket 105, the operator holds the probe 300 such that the
ultrasound beams to observe the gingiva area 515 may be as much as
possible orthogonal to a tangent vector 530 of the dental arch
curve and following the teeth axis 535. In order to ensure usable
measurements, a threshold, corresponding to the maximum deviation
angulation 540 of the ultrasonic device 315 may be specified.
[0112] While screening for the detection of tumoral mass, the
angulation monitoring is not required. Indeed, as tumoral masses do
not have a preferred direction of investigation, the benefit of the
monitoring of the probe positioning seems limited.
[0113] According to some embodiments, the maximum deviation
angulation threshold may be provided by a software application
hosted on the remote computer connected to the probe 300 (through
an input/output interface)/ or hosted on the probe itself.
[0114] The maximum deviation angulation threshold may be a
deviation angulation in relation to an initial position of the
probe. For example, the software application comprises an
initialization procedure, consisting in instructing the operator to
position at least one emitting cone of the probe in the right
position, in front of the most accessible tooth of the patient (for
example one of the incisors). The angulation of the initial
position of the probe is then registered.
[0115] Next, during the acquisition process, the deviation
angulation of the probe is monitored by the software application,
such that as soon as the angulation of the probe 300 is greater
than a maximum deviation value, the software application notifies
the operator. The maximum deviation value could be set to less than
or equal to 15.degree. preferably less than or equal to 10.degree.,
more preferably less than or equal to 5.degree. to guarantee
accurate measurement along the periodontal pocket axis. According
to some embodiments, the live deviation angulation of the probe,
during the patient examination, may be recorded, transferred or
displayed on the LCD screen of the probe or on the screen of the
computer (of the remote workstation).
[0116] According to some embodiments, the software application may
comprise features that enable the obtained images of the patient's
mouth associated with an angulation deviation greater than the
maximum deviation value to be automatically or semi-automatically
discarded.
[0117] According to some embodiments, the angulation of the probe
300 is monitored thanks to the sensor 430 mentioned with reference
to FIG. 4.
[0118] Screening of a Region of Interest of a Dental Arch
[0119] As detailed herein, a probe 300 adapted for screening a
dental arch advantageously comprises an ultrasonic periodontal
probe 300 configured for emitting ultrasound signals within an
emitting cone and for receiving corresponding echoed ultrasound
signals, as illustrated in FIGS. 3a, 3b, 3c, 4, 5a and 5b.
[0120] When using a probe 300 having two or more emitting cones
extending in different directions, in order to reduce power
consumption and to improve the quality of the results by avoiding
parasitic signals, it is advantageous to select the emitting
cone(s) to be used. The selection may be manual or automatic.
[0121] However, in order to reduce the time of a periodontal
examination or an oncological examination it is advantageous to
propose the detection of abnormalities of the periodontium or the
gingiva epitheliums, while moving the probe continuously along the
portion of the dental arch, in the gingiva area.
[0122] FIG. 8 is a diagram illustrating an example of steps of a
general method for scanning material in order to detect an
abnormality along a portion of a dental arch according to some
embodiments of the invention.
[0123] As illustrated, the general method 800 is performed while
the probe 300 moves along a portion of the dental arch 805
comprising a plurality of teeth such as the one illustrated in FIG.
5a.
[0124] As explained in reference to FIG. 5b, according to some
embodiments, the method may be performed after the user executes
the initialization procedure as described above to register the
initial position of the probe.
[0125] The method 800 comprises a step of emitting an ultrasound
signal within at least one of the emitting cones 810 facing the
tissue to be observed.
[0126] According to some embodiments, the step of emitting is
performed as a part of an acquisition process. The acquisition
process may be free, semi-automatic or automatic as detailed
hereinafter.
[0127] When using the probe illustrated in FIG. 3a that has two
emitting cones, the step of emitting may comprise a step of
selecting at least one of two emitting cones and then emitting an
ultrasound signal within the selected emitting cone.
[0128] The same applies when using a probe having several emitting
cones extending in different directions.
[0129] In order to avoid an interference between ultrasound signals
emitted within two different emitting cones, the probe may be
configured to select only one emitting cone at a time in both
emission and reception modes. An acquisition cycle (i.e. the
emission of ultrasound signal and the reception of echoed
ultrasound signal) must be completed before starting another
acquisition cycle involving either the same or a different emitting
cone. The probe may be configured in order to ensure that an
acquisition cycle is completed before starting another.
[0130] Thus, while the probe moves from area to area, tooth by
tooth, ultrasound signals are continuously emitted 810, and echoed
ultrasound signals are continuously measured 815 by the transducers
of the probe.
[0131] Steps 810 and 815 form together an acquisition cycle. During
the acquisition process, several acquisition cycles may occur.
[0132] Next, the method comprises a step of detecting at least one
anatomical structure to be investigated 820.
[0133] According to some embodiments, to do so, images of the
scanned area (tooth after tooth) are built continuously based on
the measured echoed signals, and then analyzed. The analysis allows
the detection of abnormalities of the region of interest in the
gingiva area, such as periodontal pockets of the periodontium or
masses having an echogenicity different from the one of the
gingiva's epitheliums.
[0134] According to some embodiments, the analysis of built images
may comprise two consecutive steps. The first step is to filter the
built images for identifying anatomical structures of the built
images. This step aims at identifying the objects that are visible
in the built images, meaning anatomical structures such as teeth,
gum, gingiva's epithelium, cortical bone, and periodontal
pockets.
[0135] According to some embodiments, depending on which anatomical
structures the operator would like to observe, the step of
filtering may be used to identify the meaningful images. For
example, when screening for periodontal pockets, only the image in
which periodontal pockets have been detected, are subsequently used
in the method. Same applies to ultrasonic images not presenting
tumoral tissues in case of oncological examination. Thus, images
with no interest for the operator may be automatically discarded
without any notification to the operator.
[0136] Next, the method comprises a step 825 of measuring a
predetermined feature of the at least one detected anatomical
structure to obtain a value of the measured predetermined feature
characterizing the structure.
[0137] The predetermined features may be dependent on the detected
anatomical structure. Indeed, whether the detected anatomical
structure is a periodontal pocket, the predetermined features may
be the depth or any other dimensions of the detected periodontal
pocket features. Whether the detected anatomical structures are
rather the gum and gingiva's epithelium, the predetermined features
may be the echogenicity, the textures complexity and inhomogeneity.
Indeed, tumoral masses, likely to appear in the epithelium of the
gingiva, have a different echogenicity, and different textures
complexity and inhomogeneity from a healthy epithelium of the
gingiva.
[0138] In other words, the step 825 aims at the measurement of
features of the anatomical structure previously detected (i.e. for
example, measurement of a depth of an identified periodontal pocket
or of a texture complexity of an epithelium of a gingiva). To do
so, measurements are performed on the built image in which the
structure to be characterized have been detected (in step 820).
[0139] Next, the method 800 comprises a step 830 of detecting an
abnormality as function of the threshold and the value of the
measurement of the predetermined feature of the at least one
detected anatomical structure.
[0140] This threshold may be predetermined or set by the operator
through an input/output interface of the software application
hosted on the remote computer connected to the probe or directly
through the device human interface displayed on the LCD of the
probe. The threshold may be determined dynamically during the
screening examination.
[0141] When multiple type of anatomical structures are investigated
during the same screening examination, several thresholds may be
defined and changed by the operator, each threshold being
associated to a specific type of anatomical structure (maximum of
periodontal pocket depth, maximum/minimum texture inhomogeneity of
soft tissues).
[0142] Thus, the value of each measurement of the predetermined
feature of the detected anatomical structure may be compared to a
threshold. An indicator of the probe may be configured to provide
an item of information regarding an identified abnormality. For
example, when a portion of the gingiva having an echogenicity
greater than a threshold is detected, the indicator may be actuated
to notify the possible presence of a tumor. Same applies to a
periodontal pocket having an abnormal depth.
[0143] Next, according to some embodiments, the method further
comprises a step 835 of energizing the indicator to indicate
abnormalities of the region of interest in case of detection. The
indicator may be one of the light emitting devices 425 of the
probe, the LCD screen 425, vibration means or a loudspeaker 455 as
described in reference to FIG. 4.
[0144] For example, the operator may be notified by the system
using an alert message displayed on the computer display and/or LCD
display of the probe, the vibration of the probe, the illumination
of at least one of the LEDs (continuously or discontinuously, with
color variations), or the diffusion of sound effects through the
loudspeaker.
[0145] Once the steps of the general method 800 has been performed,
the software application hosted in the remote computer or in the
microcontroller embedded in the probe, may instruct to record the
acquisition data. According to some embodiments, all the
acquisition data or only acquisition data with interest may be
recorded. For example, only data relating to a periodontal pocket
having a depth exceeding the periodontal pocket threshold or the
detection of a tumor mass having a texture inhomogeneity and/or
complexity greater than the threshold may be recorded. According to
some embodiments, both of the anatomical structure measurement and
associated image(s) (used for measurements) may be archived in the
computer, including optional notes of the operator and/or the
system (such as the tooth number, the probe positioning, the probe
angular orientation).
[0146] According to some embodiments, while moving the probe tooth
by tooth, the angulation of the probe is monitored and continuously
compared to the initial position, in order to ensure the
measurements are correctly performed. Consequently, during the
acquisition process, an angulation deviation of the probe may be
monitored, and also recorded as optional notes of archived
images.
[0147] Thanks to this method, while moving the probe along a
portion of the dental arch, the probe collects images of the
gingiva area continuously and without interruption. Consequently,
in the case of periodontal check-up, the time to perform a
periodontal assessment is significantly shortened.
[0148] Manual Screening of a Region of Interest of a Dental
Arch
[0149] In the manual mode, the operator freely moves the probe
along one or several portions of the dental arches that he or she
chooses. In other words, during a gingiva area assessment, the
operator may freely choose the areas to be assessed, in order to
complete a periodontal pocket and/or a tumoral masses assessment.
In this case, the operator freely investigates the gingiva areas in
the patient's mouth.
[0150] First, the operator selects and actuates the transducer
emitting ultrasound signals to observe the anatomical structures of
the region of interest of the patient.
[0151] According to some embodiments, when using a probe having one
emitting cone, the operator may actuate the transducer in order to
make it emit ultrasound signals. Then, the method 800 may be
performed, such that the probe continuously allows several images
of the portions of the dental arch to be obtained.
[0152] In other words, when exploring portions of the gingiva areas
of the dental arches of a patient, the operator may obtain several
images of the portions, which are automatically analyzed and
interpreted thanks to the steps 820, 825 and 830 of the method 800
(for example, for assessing the depths of detected periodontal
pockets or for detecting the presence of tumoral masses).
[0153] According to some embodiments, the operator may turn the
probe off when moving it between anatomical regions in the patient
mouth that are far apart.
[0154] According to some embodiments, when moving the probe between
anatomical regions that are far apart, the method may be
continuously performed, and images wherein no anatomical structures
of interest are detected during the step of filtering may be
automatically or semi-automatically discarded.
[0155] According to some embodiments, when using a probe such as
the one illustrated in FIGS. 3a, 3b and 3c, the operator may
actuate a transducer to make it emit ultrasound signals in the
associated emitting cone, possibly after selecting one emitting
cone from several emitting cones of the probe. The operator may
select the emitting cone according to the area of interest to be
observed. Thus, when exploring the intraoral cavity of a patient,
the operator may change the actuated transducer by another whose
arrangement is better to observe the area of interest.
[0156] According to some embodiments, the actuation of the
transducer(s) results from an actuation of a physical button
arranged on the ultrasonic imaging probe 300. As described in
relation with FIGS. 3a, 3b and 3c, each button 325-1, 325-2 can be
configured to be linked to a transducer associated with an emitting
cone.
[0157] In the case of the touch-sensitive screen, the user may
select one transducer using a finger to indicate the transducer to
be used.
[0158] According to some embodiments, the operator may actuate the
transducer(s) by choosing an item displayed on either the LCD
screen of the probe or a software graphic interface hosted on a
computer connected to the ultrasonic imaging probe 300. As
illustrated in FIG. 4, the electronic system of the imaging probe
300 can be interfaced with a remote computer (comprised in a remote
workstation) through an input/output interface. In this case, the
computer hosts a program configured to operate the probe 300, and
particularly to indicate in which direction the user wants to make
measurements, as described hereinbefore for the touch screen.
[0159] According to some embodiments, the actuated transducer
associated with the selected emitting cone may be indicated to the
operator, for example with the help of LEDs on the probe 300 and/or
on the acquisition interface of the remote computer.
[0160] Once one of the transducers has been actuated, the operator
moves the probe along the dental arch, and the method 800 is
performed in order to screen the region of interest of the dental
arches of the patient. As explained hereinbefore, after detecting
abnormalities, an indicator of probe may be energized to indicate
identified abnormalities in the region of interest investigated.
The indicator may be one of the light-emitting devices 425 of the
probe, the LCD screen 425, vibration means or the loudspeaker 455
as described in reference to FIG. 4.
[0161] For example, the operator may be notified by the system
using an alert message displayed on the computer display and/or LCD
display of the probe, the vibration of the probe, or illumination
of one of the LEDs (continuously or discontinuously, or with color
variations), or a sound effect diffused through the
loudspeaker.
[0162] Semi-Automatic or Automatic Screening of a Region of
Interest of a Dental Arch
[0163] In the semi-automatic and automatic screening of a region of
interest (such as the gingiva area), the operator is guided by the
software application through the acquisition process. The software
application comprises acquisition sequence (scenarios), indicating
the order in which the areas are scanned, meaning at which dental
arch location the acquisition may begin and end (for example a
given tooth for a periodontal assessment).
[0164] Several acquisition processes may be available to the user
and may offer to fully screen the gingiva area of a dental arch, or
a portion such as a hemi-dental arch or a dental arch quadrant. Of
course, the software application may allow the customization and/or
the creation of acquisition processes by the operator.
[0165] According to the anatomical structures to be assessed,
several acquisition processes may be available. The software
application may guide the user to scan the expected areas.
[0166] Thus, acquisition processes for periodontal examination and
for oncological examination may be different.
[0167] According to some embodiments, once the user chooses an
acquisition process on the software graphic interface, the software
application may actuate one of the transducers of the probe to make
it emit ultrasound signals within the associated emitting cone. The
actuated transducer is then indicated on the software graphic
interface to help the operator to correctly position the probe.
[0168] According to some embodiments, the actuated transducer
associated with the selected emitting cone may be indicated to the
operator, for example with the help of LEDs on the probe 300 and/or
on the acquisition interface of the remote computer.
[0169] Thus, the operator holding the probe 300 is then guided by
the software application through the acquisition process. The
software application may provide protocols ensuring the scan of a
patient's intraoral cavity in the most efficient way, by limiting
switching from one emitting cone to another. While the operator
moves the probe according to the chosen protocol, the method 800 is
performed.
[0170] According to some embodiments, after the anatomical
structure assessment in manual or automatic mode, for each
predetermined feature, the maximal and/or minimal measured feature
values of the screened areas is/are displayed, either on the
computer screen or the LCD screen of the probe.
[0171] Example of a Protocol for the Automatic Screening of
Abnormal Periodontal Pockets
[0172] When the method 800 is performed in order to detect abnormal
periodontal pockets, the predetermined feature may be for example
the depth of the periodontal pocket, as explained in the
description in relation FIG. 1. Of course, other dimensions of the
periodontal pockets may be used as predetermined features.
[0173] An example of a protocol optimizing the duration of a
periodontal pocket assessment is illustrated in FIGS. 6a, 6b, 6c
and 7a, 7b, 7c using a probe 300 configured for emitting in two
emitting cones, extending in opposite directions such as the one
described in reference to FIGS. 3a, 3b and 3c.
[0174] The probe therefore comprises an ultrasonic device 315
comprising two transducers 340, 345 that may be actuated by the
software application configured to operate the probe 300 and to
cause the transducers to emit ultrasound signals.
[0175] The illustrated protocol is carried in two phases,
respectively illustrated in FIGS. 6a, 6b, 6c and FIGS. 7a, 7b, 7c,
respectively corresponding to the actuation of transducers 340 and
345.
[0176] First, the transducer 340 is actuated by the software
application, and the operator start moving the probe. The protocol
indicates to the operator to first move the probe 300 along the
gingiva area arranged on the left lingual mandibula 600, and then
along the one arranged on the right vestibular mandibula 605. For
each dental arch quadrant 600, 605, the operator may start from the
bottom tooth of the quadrant and move the probe 300 tooth by tooth,
to scan entirely these two areas 600, 605.
[0177] When moving the probe 300 along these two areas 600, 605,
the method 800 is performed, such that several images of the areas
are continuously obtained, and existing periodontal pockets or
tumoral masses are measured. FIG. 6b illustrates the positioning of
the emitted ultrasound fan beam 620 in relation a given tooth 635
of either the left lingual mandibular 600 or the right vestibular
605 in order to obtain workable images used for measurements of
biological structures.
[0178] In the context of a fast periodontal check-up, the probe
300, in this example, emits an ultrasound fan beam 620, extending
in a plane parallel to the axis 630 of the tooth. Therefore, the
ultrasound fan beam 620 is sensibly orthogonal to a tangent vector
of the considered dental arch curve. The vector 625 represents the
acquisition scan direction in case of fan beam ultrasonic signal
generated by a moving element (transducer or deflector).
[0179] Obtained image 640 is an example of an image in which the
periodontal area of the given tooth 635 may be observed. As can be
seen, the obtained image 640 shows the area where the gum surrounds
the tooth 635, i.e. the area where the periodontal pockets are
likely to form.
[0180] Next, the operator starts moving the probe 300 following the
protocol that indicates to the operator to move the probe 300 first
along the gingiva area on the right lingual maxilla 610 and then
along the one on the left vestibular maxilla 615. The movement of
the probe 300 is the same as the one described in relation with the
scan of the quadrant 600, 605 of the dental arches.
[0181] The transducer 340 emits an ultrasound fan beam 650,
oriented similarly to the fan beam 620 in relation to the tooth
axis 655, and is illustrated in FIG. 6c in relation with a tooth
660 of either the right lingual maxilla 610 or the left vestibular
maxilla 615. The ultrasound fan beam 650 is sensibly orthogonal to
a tangent vector of the considered dental arch curve. The vector
665 represents the acquisition scan direction in case of fan beam
ultrasonic signal generated by a moving element (transducer or
deflector).
[0182] An example of the obtained image 670 shows the periodontal
area of the scanned tooth 660.
[0183] The second phase of the protocol aims at measuring the
remaining parts of the dental arches, with the second transducer
345.
[0184] First, the transducer 345 is actuated by the software
application, and the operator start moving the probe 300. The
protocol indicates to the operator to first move the probe 300
along the gingiva area on the left vestibular mandibula 700, and
then along the one on the right lingual mandibula 705. Similarly,
as described in reference to FIGS. 6a, 6b, 6c, the operator moves
the probe 300 starting from the bottom tooth of each quadrant,
tooth by tooth, while maintaining the probe in a correct position
to obtain workable images. A correct position of the probe, for the
periodontal pocket investigation, is illustrated in FIG. 7b
illustrating the ultrasound device 315 of the probe 300 emitting an
ultrasound fan beam 720 arranged such that the ultrasound fan beam
is parallel to the axis 730 of the tooth 735 and orthogonal to a
tangent vector to the dental arch curve.
[0185] The protocol next indicates to the operator to move the
probe 300 along the gingiva area on right vestibular maxilla 715,
and then along the one on the left lingual maxilla 710.
[0186] The operator respectively moves the probe along these areas
with the ultrasound signal provided by the transducer 345.
[0187] Examples of obtained images 740 and 770 show the periodontal
area, more particularly the area where the gum surrounds the teeth
735, 760.
[0188] This illustrated protocol allows the limitation of the
number of times the software application has to switch between the
transducers 340, 345.
[0189] During the protocol of assessment, the software graphic
interface may comprise indication regarding the movement of the
probe that the operator should perform. Furthermore, the software
application may notify the user when the probe positioning,
especially the angulation of the probe, does not allow correct
measurements of the biological structures that may be detected in
the obtained images. The monitoring of the probe deviation may be
performed during the anatomical structure assessments, as described
hereinbefore in reference to FIG. 5b.
[0190] Therefore, the scanning process is optimized and the amount
of time to do a complete examination of a patient's intraoral
cavity is reduced.
[0191] According to some embodiments, the protocol may specify to
perform the measurements of the vestibular parts of the upper and
lower dental arches, and then the lingual parts of the upper and
lower dental arches.
[0192] According to some embodiments, the software application may
allow additional protocols to be established by the operator.
[0193] As explained hereinbefore, after detecting abnormalities of
the region of interest investigated, an indicator of probe may be
energized to indicate identified anatomical structure
abnormalities. The indicator may be one of the light emitting
devices 425 of the probe, the LCD screen 425, vibration means and
the loudspeaker 455 as described in reference to FIG. 4.
[0194] For example, the operator may be notified by the system
using an alert message displayed on the computer display and/or LCD
display of the probe, the vibration of the probe, or illumination
of at least one of the LEDs (continuously or discontinuously, or
with color variations), or a specific sound effect diffused through
the loudspeaker.
[0195] Of course, with the help of physical buttons and/or on the
graphical interface of the software application operating the probe
300, it is possible for the operator to switch between the manual,
semi-automatic and automatic modes.
[0196] Screening of Tumoral Masses in a Patient Mouth
[0197] During the screening of tumoral masses, several
predetermined features may be measured.
[0198] As mentioned hereinbefore, when the method is performed to
detect tumoral masses during the screening examination, the
predetermined features of the detected soft tissues, i.e. gum,
epithelium of detected gingiva, are thus measured.
[0199] The predetermined features may be for example an
echogenicity indicator, a texture inhomogeneity, a texture
complexity.
[0200] An echogenicity of a tissue is the ability of the tissue to
bounce an echo. Thus, when the amplitude of the ultrasound signal
reflected by the tissues is high, these tissues have a high
echogenicity indicator (hyperechoic). These tissues are then
represented with lighter colors in the built images from echoed
ultrasound signals. Conversely, the tissues are hypoechoic when the
amplitude of the reflected ultrasound signal is low. For example,
an unusual contrast variation in the built images may therefore
indicate the presence of a tumor mass. In diseased state, the
echogenicity of an organ can be altered and become more or less
echogenic (hyperechoic or hypoechoic).
[0201] The complexity and/or the inhomogeneity of the texture of
the tissues may also characterize the internal structure of the
tissues constituting the tumor mass. For example, the complexity of
a tumoral mass can be appreciated by the fractal dimension of the
texture. These two features, individually or together, enables the
texture of tissues constituting the tumor to be assessed. Further,
these features permit the tumor evolution to be followed over
time.
[0202] Altogether, the predetermined features, echogenicity,
texture complexity and texture inhomogeneity, may help to
characterize a tumor mass when screening the region of interest
with the probe.
[0203] Consequently, it may be possible, according to some
embodiments, to perform the measurements of these three
predetermined features, and to compare the value of the
measurements respectively to three threshold associated to each
predetermined features.
[0204] Thus, a tumoral mass may be detected and characterized as a
function of the values of measurements of these predetermined
features and the thresholds.
[0205] Screening of Abnormal Several Types of Anatomical Structures
(That May Be Either Periodontal Pockets or the Presence of Tumoral
Masses)
[0206] While moving the ultrasound probe along the dental arch of
the patient, the method may be performed to detect any
abnormalities of the detected anatomical structures, i.e. either
abnormal periodontal pockets or the presence of a tumoral mass.
[0207] Then, during step 825 of the method 800, several
predetermined features are then measured on the built images, such
as the depths of the detected periodontal pockets, the high
echogenicity indicator, the texture complexity and the texture
inhomogeneity.
[0208] In case of multiple assessments during the same exam, the
measured values will be displayed either all on the same page at
the same time or successively one by one. Those displays will be
directly on the LCD screen of the probe or on the acquisition
interface of the computer of the remote workstation. Without any
operator intervention, this display will last during a few seconds,
for instance 5 seconds.
[0209] According to some embodiments, the measurements performed
during the examination may be reported in a computer file. Such a
computer file may be generated and stored in the acquisition
workstation, either in the memory of the computer of the remote
workstation, or the memory of the probe.
* * * * *