Development of Computed Echo Tomography-An Imaging Breakthrough Addressing the Limitations of Conventional Ultrasound: A Baseline Imaging Analysis for Traumatic Injuries.

Objectives: The diagnosis and triage of trauma in austere environments using ultrasound can be severely limited by bone and other obstructions, particularly when dealing with intracranial, spinal, thoracic, and long bone injuries. A novel form of ultrasound, computed echo tomography (CET), may provide for more complete "whole body" imaging capability, thereby significantly improving patient management. Methods: To document and assess the imaging capabilities of the recently Food and Drug Administration-cleared CET system (MAUI Imaging K3900), we conducted 3 whole-body imaging sessions using 6 normal volunteers. Sixty-five predefined views of 4 different anatomic regions were obtained at each session. Images were scored by 5 clinicians experienced in trauma/general surgery, emergency medicine, and/or interventional radiology using the American College of Emergency Physicians diagnostic image quality scoring system. Imaging scores ≥3 were deemed adequate for inclusion in a "head-to-toe" imaging protocol being developed for the US military. Results: Overall, 59 views (90.8%) were deemed adequate for clinical decision making. Eleven (16.9%) had average scores between 3 and 4; and 48 (73.8%) had average scores ≥4. Imaging the cranial vault demonstrated numerous anatomic details. Extremity imaging revealed detailed views of both the boney cortex and the medullary cavity. Abdominal imaging showed clear views of the liver, spleen, and kidneys without any rib artifacts. Conclusion: CET-based imaging eliminates bone-related artifacts thereby allowing access to critical brain and extremity imaging and removes rib shadows from thoracic and abdominal organ imaging. CET imaging deserves further investigation for field-based trauma diagnosis and general imaging in other resource-limited environments.