More than half (40% to 62%) of all brain injuries in Soldiers returning from recent wars in the Middle East are injuries produced by improvised explosive device (IED) explosions, where no wound site is visible. This type of injury typically needs immediate medical attention and can cause long-term medical problems in survivors if not treated. However, if the injury can be treated immediately, the patients have a much greater chance of recovery. Treatment of these injuries faces a major problem: the machines used to image the brain (computed tomography [CT] and magnetic resonance imaging [MRI], for example) and therefore diagnose the injury, cannot be transported to the locations where these injuries are most likely to occur. Most often, Soldiers must be transported to military hospitals in Germany in order to undergo these imaging procedures. However, there is usually a gap of time between injury and imaging in Germany, especially if the injury is not easily observed or if the patient does not show immediate symptoms. This means that the majority of Soldiers with brain injuries are not getting the immediate treatment that they need.

We have developed a device that uses ultrasound imaging to scan the brain for physical changes due to traumatic brain injury based upon the way the brain moves due to natural blood flow entering and leaving the brain. Brains naturally pulsate due to such blood flow. We can use this imaging modality, "tissue pulsatility imaging" or TPI. Here we seek to use it to identify and quantify structural changes to brain, hence produce structural tissue pulsatility images or sTPI. Ultrasound is an imaging technique that uses sound waves to image the body. It does not use radiation and has no known associated risks. The ultrasound device is portable (we will deploy one that has the form factor of an iPad) and can therefore be transported anywhere. Our preliminary data with sTPI gives us hope that sTPI has improved diagnostic utility compared to standard ultrasound, perhaps comparable to that of CT, the civilian screening standard. We therefore believe that scanning the brains of Soldiers who may have brain injuries with our ultrasound system would provide a diagnosis at the front lines concerning the presence of bleeding in the brain, specifically bleeding whose quick removal could significantly improve the patient's clinical outcome. Therefore, military medical care providers or their proxies would be able to see injuries quickly, without transporting Soldiers to a hospital. This would allow doctors to make earlier decisions about treatment and/or the necessity of removing a Soldier to a hospital for more intensive treatment. By diagnosing and treating the injuries earlier, doctors could prevent many of the long-term medical problems faced by Soldiers surviving brain injury and possibly even prevent the death of some Soldiers.

This ultrasound technology would also be useful for civilians. For example, in the event of a car accident, the device could travel in an ambulance with emergency care personnel, allowing them to scan the brain and make decisions about the patient's status before reaching the hospital. In small local hospitals or clinics, the ultrasound device could provide a necessary alternative to MRI or CT scanners, allowing physicians to better understand their patient's status before deciding whether they need care at a more advanced facility.

Over the next 3 years, we will perform rigorous preclinical retrospective refining and prospective testing of our sTPI as deployed on a tablet-based ultrasound imaging device for patients with moderate to severe brain injuries. At the end of 3 years, we therefore expect to have designed and tested an ultrasound system (hardware and software) that is ready for manufacturing and use in military and clinical settings.