Deep Bleeder Acoustic Coagulation (DBAC)

Thomas McCreery
Program Manager
Special Projects Office

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 Deep Bleeder Acoustic Coagulation
(DBAC)
• Program Goal
– Develop a system capable of locating and coagulating deep internal
bleeders using a combination of Doppler ultrasound for location and
high powered ultrasound for coagulation that allows untrained soldiers
to stop bleeding on the battlefield
Conceptual Implementation of DBAC Device

Ultrasonic cuff is applied Bleeder location is determined Coagulation is performed

• Operational Impact
– Needless combat deaths and amputations that occur today due to the
time delay in evacuation to a surgical facility will be prevented by treating
the deep bleeders on the battlefield
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 Program Goal
• Program Goal
– The overall goal of the DBAC program is to stop bleeding quickly enough to
prevent the transition from non-progressive shock to progressive shock, which
occurs when the soldier loses 25% of his blood volume
– The DBAC program will develop a portable, light-weight, non-invasive, automated
system for the detection, localization, and coagulation of deep bleeders that is
operable by minimally trained personnel in the combat environment
• Phase I
– Design and build the ultrasound transducer cuff and demonstration at the DBAC
testbed
• Phase II
– Design and development of the detection, localization, and coagulation algorithms
– Use these algorithms to demonstrate control of the ultrasound transducer cuff
developed in Phase I at the DBAC testbed with a human in the loop
• Phase III
– Automated system that can achieve the program goals without a human in the
loop
– Full system will be demonstrated in vitro and in vivo at the DBAC testbed.
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DBAC Notional CONOPS

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 Notional DBAC Approach
Detect Locate Coagulate

Area is scanned and Bleeder is coagulated using

Detected Bleeder is located
bleeder is detected high powered ultrasound

Detection Steps: Location Steps: Coagulation Steps:

! Scan to detect bleeder ! Optimize targeting of ! Fire transducers at
by looking for bleeder high powered subarrays bleeder site using
Doppler signal by auto focusing on phasing and multiple
! Determine subarrays Doppler signal beams to prevent
that detect a Doppler burning of tissue
shift ! Monitor coagulation
progress through
decreased Doppler
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 Scanning for Doppler Signature
Detection of Bleeder Using Doppler

• Initial scanning procedure will utilize all subarrays to look for

the Doppler signature of a bleeder

Bleeder Coupling gel to improve

ultrasound transmission and
prevent burning of skin

Artery Bone

Ultrasound Subarrays
subarrays occluded by bone

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 Automated Bleeder Location
Automated Scanning of Bleeder Location
• A conformal array made up of multiple ultrasound transducer subarrays will
be wrapped around the treatment area
– Multiple subarrays are positioned in relation to the bleeder at different angles
– This angle diversity ensures that at least one subarray will have the proper angle
to detect the bleeder
• Subarrays will fire sequentially along the array in an automated manner and
listen for the Doppler shift of a bleeder
Scanning Direction
Scanning
Direction Internal
Bleeder
Artery

• Subarrays that detect the maximum Doppler shift caused by the bleeder
will communicate to adjacent subarrays the bleeder location
• The adjacent subarrays will sweep area to locate and focus onto the
bleeder site using traditional phase delay based beam steering
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 Coagulation
Automated Coagulation of Bleeder
• High intensity focused ultrasound will be used to coagulate bleeder
• The appropriate elements of the array will be fired in unison to achieve
rapid coagulation at the site of the bleeder and minimize tissue damage
in each individual beam path
• Adjacent subarrays will operate coherently to produce a narrow focused
beam
Coupling gel to improve
ultrasound transmission and
prevent burning of skin

Bleeder

Artery Bone

Ultrasound Subarrays
subarrays occluded by bone

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 Rigid Subarrays
• Focusing of each transducer in the array to the wound area with millimeter or
less position accuracy will require:
– The position of each transducer element to the wound area
– The position of each transducer element in relation to other transducer elements
• The requirement for a flexible, conformal cuff based array makes the
achievement of the focusing requirements difficult
– Each element in a completely flexible array has no fixed position in relation to
each other transducer element
• Subarrays of transducers fixed in position to each other greatly reduce the
processing
– Resulting cuff would consist of a flexible conformal mesh of rigid subarrays

Flexible array of rigid Rigid subarray of many

subarrays individual transducers

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 Enabling Technologies from
Previous SBIR work
PZT PZT construction
Piezoelectric Ceramic
• Mount Piezoelectric
Ceramic bound to backing
layer imbedded with
electrical leads

Matching Layers Backing Block • Bond Matching Layers

Ceramic • Front-dice in the X-direction

Foil with a diamond blade to
create transducers

Backing Block • Front-dice in the Y-direction

• 0.2mm x 0.2mm x 0.5mm

Transducers

Electrical Lead
• Bond foil

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 Enabling Technologies from
Previous SBIR work (cont.)
Thousands of micromachined silicon drums are formed on a thinned silicon wafer resulting in
the formation of a flexible array of ultrasound transducers

Photo of a single silicon drum

Array with thousands of Closeup of silicon drum array
silicon drums

Flexible membrane
Vacuum
with embedded
Cavity
electrode

Silicon wafer
Pictorial cross section
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 DBAC Specs

Quantity Definition Most Challenging Specification

Problem
MDV Minimum detectable velocity Slow bleeder in 3 cm/s
small vessel
MSR Minimum structure resolution Slow bleeder in 0.06 cm
large vessel
MPD Minimum power deposition Fast bleeder in 8900 W/cm2
large vessel
MTT Maximum tissue temperature Damage to 43°C
surrounding tissue
during coagulation
MCS Minimum cuff size Man’s thigh 80 cm x 40 cm
MRC Minimum radius of curvature Woman’s bicep 3.75 cm
MDP Minimum depth penetration Man’s thigh 12.5 cm
MCW Maximum cuff weight Treating burned 3 kg
tissue
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 MDV and MSR Specs
Only discrete artery sizes exist (Examples for each vessel size are listed)

posterio
perone

femoral
arteries

dorsali
branch

tibial
pedis
small •

aorta
radia
al

ulna

iliac
Qmax = 50

l
0.45 mL/sec
Qmax = Q30 sec
0.4 Contour line showing maximum Vmax = V250 cm/sec
velocity in each vessel
0.35

MDV =
0.3
dpuncture (cm)

3 cm/sec V12.5 cm/sec

V10.4 MSR =
0.25
cm/sec 0.06 cm Protected by
V5.2 cm/sec ballistic vest
0.2 Q1 hr
Q4 hrs
0.15
Q8 hrs
V3 cm/sec
V2.2 cm/sec
0.1
Q24 hrs

0.05

0
0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 1.0
0.55 1.5
0.6 2.0
0.65 2.5
0.7 3.0
0.75
dvessel (cm)
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 MCS, MDP, and MCR Specs
Ballistic vest Leg Arm

Femoral artery (0.5 cm)

MDP =
12.5 cm
MRC =
3.75 cm

Posterior tibial artery (0.25 cm)

Radial artery (0.27 cm)
Peroneal artery (1.3 cm)
MCS =
40 x 80 cm Ulnar artery (0.2 cm)

Dorsalis pedis artery (0.15 cm)

0 10 20 30 cm 0 5 10 15 cm 0 5 10 15 cm

Vessel dimensions are exaggerated to show detail

Ballistic vest protects arteries
larger than the femoral artery The effect of punctures in these vessels is shown in slide 3
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