Ultrasound News: In a Flash
By Beth W. Orenstein
Radiology Today
Vol. 26 No. 1 P. 28

A new ultrasound device could lead to quicker triage of trauma patients.

Seriously injured patients often have to wait up to 45 minutes for a CT if they are brought to a busy trauma center. During mass casualty events, determining who can wait that long to receive care and who cannot can be dicey. An Arizona-based company, MAUI Imaging, (Multiple Aperture Ultrasound Insonification) is hoping that its new ultrasound-based technology can help solve time-to-care issues and allow better imaging and triaging of trauma patients, whether in the emergency department (ED) or in places such as battlefields and evacuation sites where resources are limited. David Specht, the founder and CEO of MAUI Imaging, describes the MAUI K3900 imaging device as a cross between ultrasound and CT. But it has the advantage of not using ionizing radiation, Specht says.

The MAUI K3900 ultrasound imaging system received 510(k) clearance from the FDA in October 2023 and has been available for commercial use since. It works by using an ultrasound probe that emits sound waves from multiple angles. Sophisticated algorithms are used to process the complex data that is received by the probe. By combining echoes from various angles, it creates a more comprehensive image than standard ultrasound, Specht explains. “With our proprietary, patented algorithms, we are able to create an image of the structures below the probe.” Unlike standard ultrasound, the MAUI Imaging system accommodates bone, which makes it particularly useful in emergency situations where the care team needs to assess internal injuries quickly, Specht says.

A germ of the idea for the probe came from Specht’s father, Don Specht, who had been working with engineers at Lockheed on the next-generation space telescope to replace Hubble. Needing to solve a variety of signal problems coming back to the telescope, they thought of using multiple wider mirrors. “Their idea was to use 10 mirrors (each 3 m in diameter) in complete alignment,” Specht says. Wider mirrors would pick up more signals and get higher resolution. Lockheed did not get the contract, but his dad discussed the work with his sons.

In 2006, the Spechts thought the idea could be applied to ultrasound for better signal processing. Their first attempt at trying their new technology was to get better images of the heart. They quickly realized they had to accommodate different tissues and soon found that with their technology, they were able to see more than could be seen with conventional ultrasound. With this knowledge, they built their new imaging device.

The processing center of the MAUI K3900 is about the size of a toolbox and weighs about 22 lbs. It requires more processing power than conventional ultrasound. “The difference between our ultrasound and conventional ultrasound devices is that conventional ultrasound is focused on one region,” Specht says. “We are more like a 3D camera. We’re sending an unfocused pulse out and we, like a camera, keep the F-stop open longer so we’re collecting all of this data, filling up our data matrix.” While MAUI’s approach requires trillions of calculations per second, its larger data set can be sliced into an infinite number of images more like CT than traditional ultrasound, Specht notes.

It is possible, Specht says, for users to zoom in on a 2-square-cm region of interest or zoom out to a larger view of the target to find out what’s going on with the patient.

MAUI’s system uses a concave probe that first fires pulses from many different angles. Because of its concave shape, it is able to see through and around barriers. “This is something no other known ultrasound-based system can accomplish,” Specht says. The larger probe makes it easier for the user to position it over a region of interest. The user doesn’t have to worry about barriers such as ribs or placing the probe perfectly.

Phasing In
In the summer of last year, the US Department of Defense (DOD) awarded MAUI Imaging a $4 million contract to study its system’s potential use in improving time-to-care in trauma settings. Since then, the contract from the DOD’s Army Medical Research and Development Command has been implemented at the University of Maryland Shock Trauma Center in Baltimore, one of the centers where the military trains trauma surgeons and others who care for trauma patients. Another trauma center affiliated with military training, the University of Alabama at Birmingham (UAB), was added in January. Three more centers are to be added shortly, Specht says.

The project is divided into phases. During the first phase, which was completed in June 2024, the company documented the baseline imaging performance of the system for more than 60 discrete anatomic regions. The anatomic regions included intracranial and spinal imaging, which are necessary for evaluations of the whole body. No other ultrasound system is capable of imaging all these regions, Specht says. A second phase is focused on comparative imaging of actual trauma pathology in the ED.

Phase II is the end of this contract. The goal is to finish a protocol for a head-to-toe Computed Echo Tomography (MAUI) FAST exam. However, the military may extend the contract or make direct purchases as part of this contract, Specht says.

Specht says physicians who have seen it in use seem interested in the device, especially its potential to create 3D images. Patients likely would need follow-up CT scans, but this could help staff triage those who need care the soonest, he says.

While the need for faster and more accessible imaging is most pronounced in trauma medicine, the company sees potential roles for its device in IR by providing detailed imaging in real time during interventions as well as in pediatric imaging because radiation exposure needs to be minimized in children. Specht also sees a role for AI with its device, helping physicians determine the best next steps for patients.

Maxwell Thompson, MD, director of emergency ultrasound at the UAB, is impressed with what he’s seen of MAUI’s ultrasound device. When MAUI pitched it to the department, which has a large military training presence, Thompson admits he was skeptical. But he found, “It really is as advertised.”

One of its most useful features, Thompson says, is that it sees around bone. That’s critical when looking for traumatic brain injuries, he says. “Brain imaging is the most unique aspect of this.” As emergency ultrasound physicians, “The brain has been the forbidden land to us. This device allows you to visualize structures in the brain in real time.”

The UAB will be involved in a phase 2 trial comparing the imaging from the MAUI device to the gold standard of advanced imaging, to “understand the diagnostic performance of this in a real-world academic trauma center like ours,” Thompson says.