Episcan®D e r m a l   U l t r a s o u n d     S c a n n e r
Pressure sore prevention * wound care * burns * dermatology
* skin cancer * cosmetic surgery * aesthetic procedures
* product research and assessment
    

See the Episcan I-200 Scanner in action The higher resolution and clarity of the images obtained using the Eipscan set it apart from other mainstream ultrasound imaging system. Click here to see a demonstration of the Episcan in action.

The EPISCAN® is a high frequency ultrasound imaging system that utilises ultrasound at frequencies as high as 50 MHz to image the skin and underlying soft tissue. The system has been designed to provide users with images of very high resolution and clarity and offers a user friendly interface enabling the EPISCAN® to be utilised in broad range of clinical applications as well as in research and development.

The high imaging resolution of the EPISCAN® differentiates it from main stream ultrasound imaging systems, which offer deeper imaging capability, but substantially less resolving capability. An illustrative image captured by Longport's EPISCAN is presented below.

Longport is committed to provide its potential and current customers with information regarding its technology, the use and benefits of high resolution ultrasound imaging and the implementation of our products into clinical applications. They are doing this through information handouts, direct customer dialogue, collaborative studies with leading medical centers and the resultant papers and presentations that arise, system and application training as well as this web site. They are committed to the advancement of this exciting new technology and hope you are able to take advantage of the information we are providing.

O V E R V I E W

The EPISCAN® has been developed to examine the human skin and first few centimeters of subdermal soft tissue using ultrasound with three alternative transducers of centre frequency range 20MHz, 35 MHz and 45 MHz. The system can resolve features down to 40 microns and displays the digitised information obtained as B scans.

Principal uses are in skin cancer, plastic surgery, dermatology including aesthetic applications and in nursing and wound care, especially in the early detection, prevention and treatment of pressure sores.

The region that the EPISCAN® has been designed to image, although including the body's largest organ, the skin, and the subject of countless diseases and traumas, is virtually neglected in regard to imaging instrumentation. To date only optical imaging has been widely applied and this exclusively provides the clinician with surface data. Information from below the surface is normally only obtained through biopsies and the subsequent preparation of tissue slides.

Ultrasound Biomicroscopy is a technique that utilises high frequency diagnostic ultrasound to examine living tissue at a microscopic level. Ultrasound medical imaging has been used for many years. It is probably best know as a tool for fetal imaging. It has been shown to be safe, reliable and cost effective. High frequency ultrasound takes this tool to a new level. Longport's technology utilises ultrasound at frequencies up to 50MHz that allows for imaging tissue at a resolution down to
40 microns. Scientists and health care professionals have been seeking a way to examine tissue at a microscopic level without the need to perform damaging biopsies. High resolution ultrasound allows for a non-invasive biopsy to be performed on tissue to a depth to 2 to 3 centimeters.

High resolution ultrasound images detail the layers of the skin and subcutaneous tissue. Subtle changes in thickness, density and fluid content can be clearly appreciated. This information can be utilised for a number of reasons. The human skin is the largest organ of the body. Pathology like chronic wounds, burns, skin cancers and skin lesions are very common. Also, the skin is affected by a number of systemic diseases making it a great indicator of these afflictions. High resolution ultrasound images provide the clinician with detailed anatomical information that can lead to better and more accurate treatments.

Photos showing computer screen images obtained with 35MHz transducer.
forearm showing longitudinal section of tendon and underlying muscles	skin lesions

R A N G E   O F   A P P L I C A T I O N S

Many clinical disciplines are expected to benefit from the use of the EPISCAN®. These include the following groupings, representative of whom Longport has met with to discuss the role of the EPISCAN®.

EPISCAN®  S y s t e m   s p e c i f i c a t i o n

Episcan® In Use - OVERVIEW

Longport’s high resolution ultrasound system the EPISCAN®-I-200 has been designed to image the skin and underlying few centimetres of soft tissue with great clarity. Ultrasound of centre frequency as high as 45 MHz can be utilized to provide clear images of the skin’s structure, visualise the impact of many of the diseases and injuries that inflict this region and monitor the impact of treatments.

The EPISCAN® software operates under Windows XP and has been designed to be user friendly as well as providing the user with a series of features and functions that allow image annotations and measurements to be performed as well as comprehensive patient record keeping. Further, digital photographs can be imported.

The EPISCAN® has been designed to occupy a small space in a clinician’s office or treatment area and can positioned on a small trolley or a desk.

Applications include:

Skin lesion mapping
Monitoring the impact of aesthetic procedures on the skin
Assessing the impact of medications on the skin
Wound and scar assessment
General assessment of skin conditions and diseases and the monitoring of treatments

30MHz Image with different palettes employed (a range of palettes are available through the EPISCAN® software)

F E A T U R E S

Many applications of the EPISCAN® relate to assessing the impact of a treatment or process, where the user is looking to measure the differences to result from their intervention normally over time. The EPISCAN® offers a series of tools to help quantitatively measure changes that may occur as well as providing the user with the ability to visually qualitatively asses sequences of images tiled on the screen.

Most simply quantitative measurements can be linear measurements or area measurements, for example measuring dermal thickness. The EPISCAN® also provides the user with the means to compare the make-up of the reflected signals that is used to create the images.

Longport has developed a high frequency ultrasound system that allows clinicians to image the skin and underlying few centimetres of soft tissue at a very high resolution. This system called the EPISCAN® enables a non-invasive visualisation of a wide range of injuries, diseases and conditions, many for the first time. The EPISCAN® has found applications in a large number of disciplines, including the appraisal of cosmetic procedures, the mapping of skin lesions and burn assessment.

Wound assessment and prevention is, however, proving to be one of the most significant applications of the EPSICAN®. In this field Longport's technology has been found to give clinicians three main advantages:

• Early and more reliable detection of developing pressure ulcers
  
  
• Improved diagnostics of existing wounds, leading to better treatments
  
  
• Advanced record keeping for wound care patients

  Considering each of these applications:

Earlier Detection of Pressure Ulcers
The EPISCAN® can visualize soft tissue through to bone at the sites where pressure ulcers normally develop and image tissue changes that precede the development of visible pressure ulcer. Significantly, this ultrasound imaging technique can detect developing pressure ulcers earlier than conventional visual techniques. Using the EPISCAN®, pressure ulcers have been found to develop in subcutaneous tissue over a hard prominence, normally a bone, and then spread out through the dermis to the epidermis, where at some point, an open wound often develops. Three distinct early phases (pre Stage 1) of pressure ulcer development can be determined using the Longport's technology. The three early phases of pressure ulcer development are shown in the ultrasound images below.

Studies have shown that the Longport ultrasound phase data can be used to initiate earlier and more targeted intervention and that this can significantly reduce the occurrence of open pressure ulcers cost effectively.

It is also possible to differentiate between friction ulcers (Pic 1 left) and/or those caused by incontinence and pressure ulcers (Pic 2 Right).

Optimization of Treatment Protocols
The EPISCAN® can image through a wound and generate a cross sectional image that can be assessed like a non-invasive biopsy. The ability to obtain these non-invasive, but histological-like images is providing clinicians with valuable data on the state and progression of wounds without the need for tissue damaging biopsies. The ability of the EPISCAN® to visualize deep into a wound, including the imaging of the wound bed, where changes to wound state often originate, and to monitor changes to this region is allowing clinicians to develop patient specific treatment protocols in a more timely manner. Image data generated by the EPISCAN® is therefore helping clinicians to heal chronic wounds faster and more effectively.

Features such as sinus tracking, wound undermining, oedema and the presence of foreign bodies can also be imaged and recorded.

Record Keeping and Audit
Centres are finding data generated by the EPISCAN® to be a useful new record of their activities and the health of their patients and that these records provide a valuable input into subsequent audits. This capability has been found to be a particularly valuable in the assessment of patients on admittance to a facility. Longport's system has been developed to integrate patient and wound assessment data (including Braden indexing), treatment protocols in relational databases together with digital photographic and ultrasound images.

The ability to generate and maintain a comprehensive electronic record in this way is expected to reduce a facility's exposure to wound related litigation and sanctions as well as save staff time.

A variety of applications are illustrated below:

The Episcan® allows for the annotation of images.

 

Label areas of interest.
Linear and area measurements
Ultrasound scan of a foreign body (Needle).

Note:

1. Foreign body distance from skin surface is 3.83 mm.
2. There is an area of inflammation around the needle of 28.82 sq mm.
3. The needle is in the tissue plain between the dermis and the deep fascia.
4. Areas of interest are annotated including the probe membrane, epidermis and the needle.

The Episcan® allows digital photographs to be imported.

Areas of interest can be annotated
The location of the each scan can be marked on the photograph
Surface area of the wound can be measured

Wound photographs demonstrate progressive improvement of wound size.

Day 1: 703.62 sq mm
Day 5: 546.00 sq mm
Day 12: 509.08 sq mm
Day 27: 480.59 sq mm

The Episcan® allows for the images to be viewed in greyscale or color palette.

A p p l i c a t i o n   E x a m p l e s

Wound Assessment and Prevention
The EPISCAN® can be a valuable tool in the assessment of chronic ulcers. It allows the user to look beneath the wounds for subtle changes that may affect clinical decision making.
The EPISCAN® can be used for the following:

• Visualization of tissue beneath the wound
• Visualization of wound undermining
• Visualization of sinus tract formation
• Visualization of sub-wound edema
• Visualization of foreign bodies
• Documentation of effectiveness of wound treatments

• Visualization of tissue beneath the wound: Up until now the care giver could only go by what they saw on the surface of the wound. The EPISCAN® allows the user to look into and beneath the wound to see what is occurring. It can aid in determining how deep the wound penetrates and help to make a judgment on the quality of the tissue beneath the wound.
• Visualization of wound undermining: It is common for wounds to undermine under the skin expanding much wider that the wound surface. The EPISCAN® allows the user to image the peri-wound area to see if it is undermined. This can change the treatment regime and require more aggressive debridement or packing of the wound.
• Visualization of sinus tract formation: Sinus tract formation is common in wounds. In fact since we can see with ultrasound that most wounds begin deep and then tunnel to the surface it would be expected that many such wounds have deep sinus tracts. The EPISCAN® can Visualization of sinus tract. This may necessitate more aggressive debridement and exploration. This can also make the care giver suspicious of osteomyelitis and further diagnostic testing may be needed.
• Visualization of sub-wound edema: Many wound care experts and researchers believe that edema under a wound is a prime reason for slow healing. A variety of treatments are aimed at reducing this edema. The EPISCAN® is the perfect tool to monitor the effectiveness of these treatments.
• Visualization of foreign bodies: There are times where there are foreign bodies within the wound tissue. This could be suture or various other structures. Examining the wound with the EPISCAN® could help identify these foreign bodies and also help navigate the clinician to the location to aid in their removal.
• Documentation of effectiveness of wound treatments: It is more and more important to document wound prevention and treatment. The EPISCAN is an excellent tool for this documentation.

The EPISCAN's Role in Pressure Ulcer Prevention and Treatment:
Pressure ulcers are a common problem in any situation where patients are compromised because of immobility, nutrition, incontinence or age. Preventive measures such as pressure relief aids, specialized beds and mattresses are expensive and therefore cannot be used for every patient. Targeting the pressure relief is a much more cost effective way to manage this problem. By having advanced knowledge that a pressure ulcer is forming, the care giver can take the appropriate steps to ward off their development. Pressure ulcers are also a prime outcome measure for extended care and acute care facilities. They are a primary cause for litigation and regulatory sanctions.

"Pressure ulcer development is an important outcome measure because it is a common complication, it is largely preventable, and it can be costly both to patients and to health care providers." US Department of Health

The reported incidence of pressure ulcers varies greatly among studies; however all agree that the incidence should be lower than what presently exists.

Where a pressure ulcer has formed, Episcan® can be used to monitor the effect of treatment. Wound closure on the outside can mask incomplete healing below, leading to premature termination of treatment and re-eruption of the pressure ulcer. Also Episcan® also detects wound undermining sideways beneath adjacent healthy skin and allows nursing staff to administer timely preventive action to stop the wound spreading.

ADVANTAGES
The advantages of the EPISCAN® in the prevention of pressure ulcers are as follows:

1. Detection of pressure ulcers before clinical signs are apparent
2. Documentation of existence of pressure ulcers on admission
3. Targeting treatments to specific anatomical areas
4. Distinguishing between pressure ulcers and friction ulcers
5. Following pre-pressure ulcers to see if treatments are effective
6. Increasing awareness and compliance of staff

Detection of pressure ulcers before clinical signs are apparent:
High resolution ultrasound has the ability to detect subtle changes in the fluid content of tissue. It has been demonstrated that the first ultrasound change that occurs in the formation of a pressure ulcer is edema in the subcutaneous tissue. This is followed by dermal and sub-epidermal edema. This information can give the care giver a "heads up" before the clinical signs of a pressure ulcer are seen. Pressure relief and skin care can then be targeted before the ulcer has developed further.
Documentation of existence of pressure ulcers on admission:
There has always been a conflict over who is responsible for the formation of a pressure ulcer. Very often patients are transferred from one facility to another with a pressure ulcer already forming. By doing an ultrasound exam upon admission the receiving facility can document if a pressure ulcer is already forming. This could reduce liability and regulatory sanctions and fines.
Targeting of treatments to specific anatomical areas:
Providing pressure relief and skin care to all patients and anatomical parts is costly, time consuming and often not practical. The EPISCAN® exam allows for the treatments to target the patient and areas that need them the most. This can result in better outcomes and more efficient use of staff and materials.
Distinguishing between pressure ulcers and friction ulcers:
Often, there is no distinction made between pressure ulcers and friction and incontinence ulcers, although the treatment regime can be different. The EPISCAN® exam can distinguish between types of ulcers. This allows for more effective treatments of the ulcer.
Following pre-pressure ulcers to see if treatments are effective:
Once a pressure ulcer is seen developing on ultrasound appropriate care is initiated to reverse the process. Up until now there has been no effective way to measure the effectiveness of these modalities. Follow up exams can document the effectiveness of the treatment given.
Increasing awareness and compliance of staff:
There was a study performed at Yale University utilizing the EPISCAN® in the treatment and prevention of pressure ulcers. One of the conclusions of this study is that it increased the awareness and compliance of the staff. By demonstrating ultrasound evidence of pressure ulcer formation staff members are more likely to take clinically appropriate action. Also, by showing the results of their efforts with improved scans, the outcomes of their actions are reinforced.

Note: Q.Light phototherapy is extremely effective in stimulating healing of pressure sores and chronic wounds. Application is simple and requires no special training or safety precautions. Just a few minutes daily during change of dressings can produce remarkable results, which are easily confirmed by Episcan. Click here for further details

Extended Care

The Use of the EPISCAN® in Extended Care Facilities   The EPISCAN® is ideal for use within an extended care facility. Its portability allows it to be used in patient rooms. Its ease of use makes it possible to do an exam in a minimal amount of time. The ultimate goal of the use of the EPISCAN® in extended care facilities is to reduce the incidence of pressure ulcer formation.

It is recommended that the use of the EPISCAN® be incorporated into existing facility skin care protocols. Each patient should be evaluated by standard indexes (Braden etc.) to determine their propensity to pressure ulcer formation. Patients that have a high index rating should have a careful skin evaluation including ultrasound scanning. The patient is also evaluated for their position, continence and mobility. High risk anatomical sites are identified, evaluated and scanned. . The ultrasound examination adds about ten minutes to the standard exam. This time spent will be more than made up if the incidence of pressure ulcers is reduced. It has been found that it is ideal to have two people for this exam. Most of these patients are immobile and it is difficult to turn and reposition them. A two person team makes it more efficient and more comfortable for the patient.

Each scan is evaluated to see if there are any signs that a pressure ulcer is forming. Clinical signs such as non-blanching erythema and bogginess are noted. Any site that has either ultrasound changes and/or clinical signs of a pressure ulcer is immediately targeted for treatment. Scans are labeled and saved in a database for that patient. Patients can be rescanned as needed. If they continue to be immobile and have other risk factors examination and scanning should be performed weekly.

Areas that have demonstrated ultrasound changes indicative of pressure ulcer formation should be scanned on a regular basis to see if treatment regimes are working.

In existing pressure ulcers the ulcer should be scanned to help aid in the evaluation of the ulcer. Scans can be repeated as necessary to determine if treatments are being effective. Digital photographs can also be recorded for each wound. The EPISCAN® software allows for accurate measurement of wounds form the digital photographs. The photographs can also be marked at the location on the wound where the scan was taken.

The EPISCAN® can become an integral part of an extended care facilities total care plan for pressure ulcer prevention and treatment.

Clinical Dermatology
The EPISCAN® is able to image the human skin to very high resolution and to differentiate between subtle changes in tissue structure. Thus it is an ideal tool for dermatologists to assess various conditions and diseases, determine the effectiveness of treatments and to help plan surgery.

Skin Lesion Assessment
High frequency ultrasound can be used to map skin lesions; enabling clinicians to quantitatively assess the impact of non-surgical treatments such as photo dynamic therapy (PDT) and to provide input into surgical planning.

		In addition to imaging the skin high frequency ultrasound can be used to image nails and nail beds.

Aesthetics and Plastics
Longport's EPISCAN ultrasound imaging system can image the dermal structure to high resolution and with great clarity enabling subtle changes in tissue structure to be visualised. Thus it is possible to visualise the effects of ageing, damage caused by sun exposure and the impact of various aesthetics treatments on the skin. Importantly, changes before and after treatment can be compared both qualitatively and quantitatively, allowing the clinician and patient to see the impact of treatment programs often before visual impact can be seen.

Sun Induced Damage
Note the increase thickness of the dermas in the sun exposed image compared with the sun protected area. Also, the reduced intensity of reflections from the upper, papillary, region of the dermis in the sun exposed area, indicating a weaker collagen structure.

The EPISCAN® is currently being used to evaluate the impact of various skin rejuvenating laser treatments, where changes in the ultrasound structure of the skin can often be seen prior to visual changes, fillers, including confirming that these are injected into the correct plane of the dermis and other anti-ageing treatments.

The EPISCAN® can also be used to image cellulite and scar tissue, including keloid scars.

High Frequency Ultrasound Image of Cellulite	High Frequency Ultrasound Image of Keloid Scar

Quantitative Analysis
Many applications of the EPISCAN® relate to assessing the impact of a treatment or process, where the clinician is looking to measure the differences to result from their intervention. The EPISCAN® offers a series of tools to help quantitatively measure changes that may occur as well as providing the user with the ability to visually qualitatively asses sequences of images tiled on the screen. Most simply quantitative measurements can be linear measurements, for example measuring dermal thickness. The EPISCAN® however also provides the user with the means to compare the make-up of the reflected signals that are used to create the images.

The EPISCAN® can utilize the signal strength of each pixel, that makes up an image or area of image, to show subtle changes in tissue characteristics. (Refereed to here as pixel analysis.) In the following example the same area of skin before, during and one hour after saturation with a moisturiser was utilized. One each image an identical area was defined for analysis and the pixel intensity distribution determined within that defined area.

These plots show that prior to the application of the moisturizer the average intensity of the pixels was higher and that one hour after the removal of the surplus moisturizer there had been a small but measurable change back towards the pre application condition. (This trend is as expected as moisturizing or hydrating of the skin lessens the ultrasound reflections.)
This analysis is taken one stage further in the table below where each of the distribution plots is represented by numeric values.

The application of this analysis technique is being investigated to provide numerical representation of skin ageing or rejuvenation.

IMAGE LIBRARY
View Images below, or select from another category

Normal Tissue

Wounds

Pressure Ulcers

Clinical Dermatology

Aesthetics

Normal Images
	35 MHz image of thin skin (anterior thigh) in gray scale including a hair follicle and its corresponding arrector pili.
	50 MHz image of thin skin (anterior thigh) in gray scale including a multiple hair follicles.
	Deeper 35 MHz image of the wrist in color palette showing the radial artery.
	35 MHz image of the forearm showing a longitudinal section of tendon and underlying muscle.
	35 MHz image of thick skin (palm of hand) in color palette demonstrating the multiple layers of the epidermis.
	Deeper 35 MHz image of thick skin (palm of hand) in color palette including a subcutaneous blood vessel.
	35 MHz image of nail bed
Wounds
	Ultrasound image of an ankle wound seen above taken as indicated by yellow marker. Image shows minimal edema under wound with no undermining or sinus tract.
Pressure Ulcers
	Image of the heel showing normal anatomy and reflection off bone.
	Image of the heel showing pockets of low reflection indicating edema and suggesting a pre-ulcer caused by pressure.
	mage of the sacrum showing edema directly under the epidermis suggestive of a friction ulcer.
Clinical Dermatology
	50 MHz image of a skin lesion and adjacent hair follicle
	35MHz image of skin lesion
	35MHz image of skin lesion
	35 MHz image of a basal cell carcinoma
	20 MHz image of a squamous cell carcinoma
Aesthetics
	35 MHz image of cellulite. Note sculptured edges of the dermis.
	35 MHz image of a keloid.
	mage (left) of normal skin of the abdomen. Adjacent Image (right) of scar tissue of the abdomen.

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For more references and information on training courses for general practitioners and other medical personnel please visit the training section of this site.

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