US20100256490A1 - Medical system having an ultrasound source and an acoustic coupling medium - Google Patents

Abstract

An ultrasound medical system has an end effector including a medical ultrasound transducer and an acoustic coupling medium. The acoustic coupling medium has a transducer-proximal surface and a transducer-distal surface. The medical ultrasound transducer is positioned to emit medical ultrasound through the acoustic coupling medium from the transducer-proximal surface to the transducer-distal surface. The end effector is adapted to change a property (such as the shape and/or the temperature) of the acoustic coupling medium during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during a medical procedure on a patient. In one example, such changes are used to change the focus and/or beam angle of the emitted ultrasound during the medical procedure.

Description

REFERENCE TO RELATED APPLICATIONS
• The present application is a continuation of U.S. patent Ser. No. 10/848,550 filed May 18, 2004, the contents of which are incorporated herein by reference.
FIELD OF THE INVENTION
• The present invention relates generally to ultrasound, and more particularly to an ultrasound medical system having an ultrasound source and an acoustic coupling medium.
BACKGROUND OF THE INVENTION
• Known ultrasound medical methods include using ultrasound imaging (at low power) of patients to identify patient tissue for medical treatment and include using ultrasound (at high power), from the same or a different ultrasound transducer, to ablate identified patient tissue by heating the tissue.
• Known ultrasound medical systems and methods include deploying an end effector having an ultrasound transducer outside the body to break up kidney stones inside the body, endoscopically inserting an end effector having an ultrasound transducer in the rectum to medically destroy prostate cancer, laparoscopically inserting an end effector having an ultrasound transducer in the abdominal cavity to medically destroy a cancerous liver tumor, intravenously inserting a catheter end effector having an ultrasound transducer into a vein in the arm and moving the catheter to the heart to medically destroy diseased heart tissue, and interstitially inserting a needle end effector having an ultrasound transducer needle into the tongue to medically destroy tissue to reduce tongue volume to reduce snoring.
• Conventional ultrasound medical systems include a system having an end effector including a medical ultrasound transducer, a sheath, and a water acoustic coupling medium. The end effector is inserted into a patient, and a balloon portion (which acts as an acoustic window) of the sheath is expanded by increasing water pressure until the balloon portion contacts patient tissue. Then, the medical ultrasound transducer emits medical ultrasound through the balloon portion via the water to image and/or treat the patient tissue.
• Still, scientists and engineers continue to seek improved ultrasound medical systems.
SUMMARY OF THE INVENTION
• A first expression of an embodiment of the invention is an ultrasound medical system having an end effector including a medical ultrasound transducer and an acoustic coupling medium. The acoustic coupling medium has a transducer-proximal surface and a transducer-distal surface. The medical ultrasound transducer is positioned to emit medical ultrasound through the acoustic coupling medium from the transducer-proximal surface to the transducer-distal surface. The end effector is adapted to change at least one property of the acoustic coupling medium during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during a medical procedure on a patient.
• A second expression of an embodiment of the invention is an ultrasound medical system having a controller and an end effector. The end effector includes a medical ultrasound transducer and an acoustic coupling medium. The acoustic coupling medium has a transducer-proximal surface and a transducer-distal surface. The medical ultrasound transducer is positioned to emit medical ultrasound having a focus and a beam angle through the acoustic coupling medium from the transducer-proximal surface to the transducer-distal surface. The end effector is adapted to change at least one property of the acoustic coupling medium during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during a medical procedure on a patient. The controller controls the end effector to change the property to change the focus and/or the beam angle.
• A third expression of an embodiment of the invention is an ultrasound medical system having a controller and an end effector. The end effector includes a medical ultrasound transducer, an acoustic coupling medium, and a sheath. The sheath includes an expandable acoustic window, wherein the acoustic coupling medium is placed in direct contact with the medical ultrasound transducer and the acoustic window. The medical ultrasound transducer is positioned to emit medical ultrasound through the acoustic window via the acoustic coupling medium. The controller controls the end effector to change the shape of the acoustic window, by changing the pressure exerted by the acoustic coupling medium against the acoustic window, during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during a medical procedure on a patient.
• Several benefits and advantages are obtained from one or more of the expressions of an embodiment of the ultrasound medical system of the invention. The acoustic coupling medium also acts as an acoustic lens, wherein the end effector is adapted to change at least one property (such as the shape and/or the temperature) of the acoustic coupling medium which will change the focus and/or the beam angle of emitted ultrasound, with such changes occurring during emission, and/or between emissions, of ultrasound while performing a medical procedure on a patient.
• The present invention has, without limitation, application in conventional endoscopic, laparoscopic, and open surgical instrumentation as well as application in robotic-assisted surgery.
BRIEF DESCRIPTION OF THE FIGURES
• FIG. 1 is a perspective view of a first embodiment of an ultrasound medical system of the invention including a controller and an end effector, wherein the end effector is seen inserted into a patient (only a portion of whom is shown) and has an acoustic window, and wherein the end effector is adapted to change the shape of the acoustic window during a medical procedure by increasing the pressure of an acoustic coupling medium located inside the end effector;
• FIG. 2 is a schematic cross-sectional view of the end effector of the ultrasound medical system ofFIG. 1, wherein the adaptation of the end effector is shown and includes a movable piston which exerts pressure on the acoustic coupling medium;
• FIG. 3 is a schematic cross-sectional view of an end effector of a second embodiment of an ultrasound medical system of the invention, wherein the end effector has an acoustic coupling medium, and wherein the end effector is adapted to change the shape of the medium-patient interface during a medical procedure, such adaptation being omitted for clarity;
• FIG. 4 is a schematic cross-sectional view of an end effector of a third embodiment of an ultrasound medical system of the invention, wherein the end effector has an acoustic window and has an acoustic coupling medium located inside the end effector, wherein the end effector is adapted to change the temperature of the acoustic coupling medium during a medical procedure, and wherein the adaptation of the end effector includes a heater; and
• FIG. 5 is a schematic cross-sectional view of an end effector of a fourth embodiment of an ultrasound medical system of the invention, wherein the end effector has an acoustic coupling medium and is adapted to change the temperature of the acoustic coupling medium during a medical procedure, such adaptation being omitted for clarity.
DETAILED DESCRIPTION OF THE INVENTION
• Before explaining the present invention in detail, it should be noted that the invention is not limited in its application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative embodiments of the invention may be implemented or incorporated in other embodiments, variations and modifications, and may be practiced or carried out in various ways. Furthermore, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative embodiments of the present invention for the convenience of the reader and are not for the purpose of limiting the invention.
• It is understood that any one or more of the following-described embodiments, examples, etc. can be combined with any one or more of the other following-described embodiments, examples, etc.
• Referring now to the drawings,FIGS. 1-2 illustrate an embodiment of the present invention. A first expression of the embodiment ofFIGS. 1-2 is an ultrasoundmedical system110 comprising anend effector112 including amedical ultrasound transducer114 and anacoustic coupling medium116. Theacoustic coupling medium116 has a transducer-proximal surface118 and a transducer-distal surface120. Themedical ultrasound transducer114 is disposed to emit medical ultrasound through theacoustic coupling medium116 from the transducer-proximal surface118 to the transducer-distal surface120. Theend effector112 is adapted to change at least one property of theacoustic coupling medium116 during emission, and/or between emissions, of medical ultrasound from themedical ultrasound transducer114 during a medical procedure on apatient122. The terminology “ultrasound medical system” includes an ultrasound medical imaging system, an ultrasound medical treatment system, and an ultrasound medical imaging and ultrasound medical treatment system. The terminology “medical procedure” includes an imaging procedure, a treatment procedure, and an imaging and treatment procedure.
• In an enablement of the first expression of the embodiment ofFIGS. 1-2, the at-least-one property includes shape, and theend effector112 is adapted to change the shape (such as the curvature) of the transducer-distal surface120 during emission, and/or between emissions, of medical ultrasound from themedical ultrasound transducer114 during the medical procedure.
• In one variation of this enablement, as shown in the embodiment ofFIG. 3, the transducer-distal surface220 of theacoustic coupling medium216 is disposable in direct contact with patient tissue. In one modification, theend effector212 of the ultrasoundmedical system210 changes the pressure exerted by theacoustic coupling medium216 against the patient tissue when the transducer-distal surface220 of theacoustic coupling medium216 is disposed in direct contact with patient tissue during the medical procedure. In one construction, the medical ultrasound transducer214 is disposed in direct contact with the transducer-proximal surface218 of theacoustic coupling medium216. In one application, ultrasound imaging from the medical ultrasound transducer214 or another ultrasound transducer is used to determine the shape of the interface between the transducer-distal surface220 of theacoustic coupling medium216 and the patient tissue. It is noted that the interface acts as an acoustic lens surface, and that changing the shape of the interface during the medical procedure can be used to change the focus and/or the beam angle of the ultrasound emitted from the medical ultrasound transducer214 during the medical procedure when such ultrasound non-perpendicularly passes through the interface. In one option, ultrasound strain imaging of patient tissue is performed by the ultrasoundmedical system210.
• In a different variation of this enablement, as shown in the embodiment ofFIGS. 1-2, theend effector112 also includes an expandableacoustic window126 having aninterior surface128 in direct contact with the transducer-distal surface120 of theacoustic coupling medium116 and having anexterior surface130 disposable in direct contact withpatient tissue124. In one modification, theend effector112 changes the pressure exerted by theacoustic coupling medium116 against theacoustic window126 when theexterior surface130 of theacoustic window126 is disposed in direct contact withpatient tissue124 during the medical procedure. In one construction, themedical ultrasound transducer114 is disposed in direct contact with the transducer-proximal surface118 of theacoustic coupling medium116. In one application, ultrasound imaging from themedical ultrasound transducer114 or another ultrasound transducer is used to determine the shape of the interface between the transducer-distal surface120 of theacoustic coupling medium116 and theinterior surface128 of theacoustic window126 and the shape of the interface between theexterior surface130 of theacoustic window126 and thepatient tissue124. In one variation, theacoustic window126 is a fully-circumferential acoustic window and in another variation it is not. In one option, ultrasound strain imaging ofpatient tissue124 is performed by the ultrasound medical system.
• It is noted that the interfaces act as acoustic lens surfaces, and that changing the shape of the interfaces during the medical procedure can be used to change the focus and/or the beam angle of the ultrasound emitted from themedical ultrasound transducer114 during the medical procedure when such ultrasound non-perpendicularly passes through the interfaces. In one application, theacoustic coupling medium116 is circulating water, wherein changing the flow rate of the circulating water changes the pressure exerted by theacoustic coupling medium116 against theacoustic window126. It is also noted that a change in shape (such as a change in curvature) of theacoustic window126 typically is accompanied by a change in thickness of theacoustic window126 and a change in the distance between themedical ultrasound transducer114 and theacoustic window126 which can also effect focus and/or beam angle as is understood by those skilled in the art. In one implementation, theacoustic window126 is provided with a transducer-distal surface120 which is rippled (not shown) for use in beam angle steering as is within the level of skill of the artisan.
• In the same or a different enablement, as shown in the embodiment ofFIG. 4, the at-least-one property includes temperature, and theend effector312 of the ultrasoundmedical system310 is adapted to change the temperature of theacoustic coupling medium316 during emission, and/or between emissions, of medical ultrasound from themedical ultrasound transducer314 during the medical procedure. Changing the temperature of theacoustic coupling medium316 changes the speed of sound of the emitted ultrasound in theacoustic coupling medium316 which can be used by those skilled in the art to change the focus and/or the beam angle of the emitted ultrasound when non-perpendicularly passing through a transmission medium interface. It is noted that the embodiment ofFIG. 4 includes a rigid or expandableacoustic window326, and that the embodiment of the ultrasoundmedical system410 ofFIG. 5 is identical to that ofFIG. 4 except that theend effector412 ofFIG. 5 lacks an acoustic window.
• In one example of any one or more or all of the embodiments ofFIGS. 1-5, themedical ultrasound transducer114,214,314 and/or414 is chosen from the group consisting of a medical-imaging-only ultrasound transducer, a medical-treatment-only ultrasound transducer, and a medical-imaging-and-treatment ultrasound transducer. In one variation, the medical ultrasound transducer has a single transducer element having a planar or a curved ultrasound-emitting surface. In another variation, the medical ultrasound transducer has an array of transducer elements whose planar or curved ultrasound-emitting surfaces are together disposed to define a curved array surface or whose planar ultrasound-emitting surfaces are together disposed to define a planar array surface. In one modification, the transducer element array is also electronically focused and/or steered as is within the routine capabilities of those skilled in the art. In one extension, the end effector has one or more additional medical ultrasound transducers.
• In the same or a different example, theacoustic coupling medium116,216,316 and/or416 is chosen from the group consisting of a liquid, a gel, and a colloid. In one variation, the acoustic coupling medium is a circulating acoustic coupling medium and in a different variation it is not circulating. Examples of liquids include, without limitation, water, a saline solution, glycerol, castor oil, and mineral oil. Other examples of liquids and examples of gels and colloids and other acoustic coupling media are left to the artisan.
• In one implementation any one or more or all of the embodiments ofFIGS. 1-5, theend effector112,212,312 and/or412 is disposable against an outside surface of the patient. In another implementation, the end effector is insertable into the patient.
• A second expression of the embodiment ofFIGS. 1-2 is an ultrasoundmedical system110 comprising acontroller132 and anend effector112. Theend effector112 includes amedical ultrasound transducer114 and anacoustic coupling medium116. Theacoustic coupling medium116 has a transducer-proximal surface118 and a transducer-distal surface120. Themedical ultrasound transducer114 is disposed to emit medical ultrasound through theacoustic coupling medium116 from the transducer-proximal surface118 to the transducer-distal surface120. Theend effector112 is adapted to change at least one property of theacoustic coupling medium116 during emission, and/or between emissions, of medical ultrasound from themedical ultrasound transducer114 during a medical procedure on apatient122. Thecontroller132 controls theend effector112 to change the property to change ultrasound focus and/or ultrasound beam angle. In one extension of the embodiments ofFIGS. 3-5, and in any one or more or all of the enablements, examples, etc. thereof, the ultrasound medical systems ofFIGS. 3-5 also include the controller of the second expression of the embodiment ofFIGS. 1-2.
• A third expression of the embodiment ofFIGS. 1-2 is an ultrasoundmedical system110 comprising acontroller132 and anend effector112. Theend effector112 includes amedical ultrasound transducer114, anacoustic coupling medium116, and a rigid orflexible sheath134. Thesheath134 includes an expandableacoustic window126. Theacoustic coupling medium116 is disposed in direct contact with themedical ultrasound transducer114 and theacoustic window126. Themedical ultrasound transducer114 is disposed to emit medical ultrasound through theacoustic window126 via theacoustic coupling medium116. Thecontroller132 controls theend effector112 to change the shape of theacoustic window126, by changing (directly or indirectly) the pressure exerted by theacoustic coupling medium116 against theacoustic window126, during emission, and/or between emissions, of medical ultrasound from themedical ultrasound transducer114 during a medical procedure on apatient122.
• In one example of the third expression of the embodiment ofFIGS. 1-2, a piston is used to directly change the pressure of an essentially static acoustic coupling medium. In another example, a valve is used to change the flow rate (and hence is used to indirectly change the pressure) of a flowing acoustic coupling medium. In one employment of the third expression of the embodiment ofFIGS. 1-2, thecontroller132 controls theend effector112 to change the thickness of theacoustic window126, by changing the pressure exerted by theacoustic coupling medium116 against theacoustic window126, during emission, and/or between emissions, of medical ultrasound from themedical ultrasound transducer114 during a medical procedure on apatient122.
• In one arrangement of the embodiment ofFIGS. 1-2, the ultrasoundmedical system110 also includes acable136, ahandpiece138, and a rigid orflexible shaft140. In this arrangement, thecable136 operatively connects thecontroller132 to thehandpiece138, thehandpiece138 is operatively connected to theend effector112, and theshaft140 supports themedical ultrasound transducer114 and is operatively connected to thehandpiece138. Theshaft140 can be rotatable or non-rotatable with respect to thehandpiece138. Other arrangements are left to the artisan.
• In one construction of the third expression of the embodiment ofFIGS. 1-2, a thinner part of the sheath acts as the acoustic window. In another construction, the acoustic window is made from a different material or materials than the material or materials of the non-acoustic-window portion of the sheath. In an additional construction, the entire sheath acts as the acoustic window. Other constructions are left to the artisan.
• Examples of acoustically-transmissive materials for acoustic windows include, without limitation, PET [polyethylene terephthalate] (such as 0.001-inch-thick PET for a fully-circumferential acoustic window), Nylon 6, 11 or 12, TPX [methylpentene copolymer] and flouropolymers such as PTFE [polytetrafluoroethylene], FEP [fluorinated ethylene propylene], PFA [perfluoroalkoxy], PVDA [polyvinylidene acetate], ETFE [ethylene tetrofluoroethylene], polyurethane and polyethylene (high and low density). Shaft and sheath materials, for flexible shafts and sheaths, include, without limitation, Nitinol, polyimide, reinforced polyimide, Nylon, Pebax, silicone, reinforced silicone, polyurethane, polyethylene, flouropolymers and coiled metals (e.g., coiled stainless steel).
• In one deployment of the ultrasoundmedical system110 ofFIGS. 1-2, theend effector112 is adapted to change the shape of the transducer-distal surface120 of theacoustic coupling medium116 by having theend effector112 include anannular piston142, movable by an attached annular piston rod144. Themovable piston142 is used to change the pressure of a non-circulatingacoustic coupling medium116 to change the curvature of the transducer-distal surface120 of the acoustic coupling medium115 (which changes the curvature of the acoustic window126). In a different deployment, not shown, theend effector112 is adapted by having theend effector112 include a channel for theacoustic coupling medium116 extending from the area of theacoustic window126 to an orifice connectable to a variable-pressure-exerting device.
• In one deployment of the ultrasoundmedical system310 ofFIG. 4, theend effector312 is adapted by having theend effector312 include aheater346 which is used to change the temperature of theacoustic coupling medium316. In a different deployment, not shown, theend effector312 is adapted by having theend effector312 include a channel for theacoustic coupling medium316 extending from the area of theacoustic window326 to an orifice connectable to a heating device.
• In a further deployment of the ultrasound medical systems ofFIGS. 1-2 andFIG. 5, a tube (not shown) surrounds the shaft, is radially spaced apart from the shaft and the sheath, and longitudinally extends proximate the acoustic window with, for example, circulating water as the acoustic coupling medium which enters the ultrasound transducer-acoustic window area from the channel between the shaft and the tube and which exits the ultrasound transducer-acoustic window area from the channel between the tube and the sheath. In one variation, a pump (not shown) varies the flow rate of the water. In such adaptation of the end effector, an increasing flow rate increases the pressure of the circulating acoustic coupling medium which changes the shape of the transducer-distal surface of the acoustic coupling medium (in both theFIGS. 1-2 andFIG. 5 ultrasound medical systems) and hence the shape of the acoustic window (in theFIGS. 1-2 ultrasound medical system). Other deployments are left to the artisan.
• Several benefits and advantages are obtained from one or more of the expressions of an embodiment of the ultrasound medical system of the invention. The acoustic coupling medium also acts as an acoustic lens, wherein the end effector is adapted to change at least one property (such as the shape and/or the temperature) of the acoustic coupling medium which will change the focus and/or the beam angle of emitted ultrasound, with such changes occurring during emission, and/or between emissions, of ultrasound while performing a medical procedure on a patient.
• While the present invention has been illustrated by a description of several embodiments, it is not the intention of the applicants to restrict or limit the spirit and scope of the appended claims to such detail. Numerous other variations, changes, and substitutions will occur to those skilled in the art without departing from the scope of the invention. For instance, the ultrasound medical system of the invention has application in robotic assisted surgery taking into account the obvious modifications of such systems, components and methods to be compatible with such a robotic system. It will be understood that the foregoing description is provided by way of example, and that other modifications may occur to those skilled in the art without departing from the scope and spirit of the appended Claims.

Claims (20)

1. An ultrasound medical system comprising an end effector including a medical ultrasound transducer and an acoustic coupling medium, wherein the acoustic coupling medium has a transducer-proximal surface and a transducer-distal surface, wherein the medical ultrasound transducer is disposed to emit medical ultrasound through the acoustic coupling medium from the transducer-proximal surface to the transducer-distal surface, and wherein the end effector is adapted to change at least one property of the acoustic coupling medium during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during a medical procedure on a patient.

2. The ultrasound medical system ofclaim 1, wherein the at-least-one property includes shape, and wherein the end effector is adapted to change the shape of the transducer-distal surface during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during the medical procedure.

3. The ultrasound medical system ofclaim 2, wherein the transducer-distal surface of the acoustic coupling medium is disposable in direct contact with patient tissue.

4. The ultrasound medical system ofclaim 3, wherein the end effector changes the pressure exerted by the acoustic coupling medium against the patient tissue when the transducer-distal surface of the acoustic coupling medium is disposed in direct contact with patient tissue during the medical procedure.

5. The ultrasound medical system ofclaim 2, wherein the end effector also includes an expandable acoustic window having an interior surface in direct contact with the transducer-distal surface of the acoustic coupling medium and having an exterior surface disposable in direct contact with patient tissue.

6. The ultrasound medical system ofclaim 5, wherein the end effector changes the pressure exerted by the acoustic coupling medium against the acoustic window when the exterior surface of the acoustic window is disposed in direct contact with patient tissue during the medical procedure.

7. The ultrasound medical system ofclaim 1, wherein the at-least-one property includes temperature, and wherein the end effector is adapted to change the temperature of the acoustic coupling medium during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during the medical procedure.

8. The ultrasound medical system ofclaim 1, wherein the medical ultrasound transducer is chosen from the group consisting of a medical-imaging-only ultrasound transducer, a medical-treatment-only ultrasound transducer, and a medical-imaging-and-treatment ultrasound transducer.

9. The ultrasound medical system ofclaim 1, wherein the acoustic coupling medium is chosen from the group consisting of a liquid, a gel, and a colloid.

10. The ultrasound medical system ofclaim 1, wherein the end effector is disposable against an outside surface of the patient.

11. The ultrasound medical system ofclaim 1, wherein the end effector is insertable into the patient.

12. An ultrasound medical system comprising a controller and an end effector, wherein the end effector includes a medical ultrasound transducer and an acoustic coupling medium, wherein the acoustic coupling medium has a transducer-proximal surface and a transducer-distal surface, wherein the medical ultrasound transducer is disposed to emit medical ultrasound through the acoustic coupling medium from the transducer-proximal surface to the transducer-distal surface, wherein the end effector is adapted to change at least one property of the acoustic coupling medium during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during a medical procedure on a patient, and wherein the controller controls the end effector to change the property to change ultrasound focus and/or ultrasound beam angle.

13. The ultrasound medical system ofclaim 12, wherein the at-least-one property includes shape, and wherein the end effector is adapted to change the shape of the transducer-distal surface during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during the medical procedure.

14. The ultrasound medical system ofclaim 12, wherein the at-least-one property includes temperature, and wherein the end effector is adapted to change the temperature of the acoustic coupling medium during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during the medical procedure.

15. The ultrasound medical system ofclaim 12, wherein the medical ultrasound transducer is chosen from the group consisting of a medical-imaging-only ultrasound transducer, a medical-treatment-only ultrasound transducer, and a medical-imaging-and-treatment ultrasound transducer.

16. The ultrasound medical system ofclaim 12, wherein the acoustic coupling medium is chosen from the group consisting of a liquid, a gel, and a colloid.

17. The ultrasound medical system ofclaim 12, wherein the end effector is disposable against an outside surface of the patient.

18. The ultrasound medical system ofclaim 12, wherein the end effector is insertable into the patient.

19. An ultrasound medical system comprising a controller and an end effector, wherein the end effector includes a medical ultrasound transducer, an acoustic coupling medium, and a sheath, wherein the sheath includes an expandable acoustic window, wherein the acoustic coupling medium is disposed in direct contact with the medical ultrasound transducer and the acoustic window, wherein the medical ultrasound transducer is disposed to emit medical ultrasound through the acoustic window via the acoustic coupling medium, and wherein the controller controls the end effector to change the shape of the acoustic window, by changing the pressure exerted by the acoustic coupling medium against the acoustic window, during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during a medical procedure on a patient.

20. The ultrasound medical system ofclaim 19, wherein the controller controls the end effector to change the thickness of the acoustic window, by changing the pressure exerted by the acoustic coupling medium against the acoustic window, during emission, and/or between emissions, of medical ultrasound from the medical ultrasound transducer during a medical procedure on a patient.

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