WO2000009014A1

WO2000009014A1 - Combined ultrasound-radiography apparatuses

Info

Publication number: WO2000009014A1
Application number: PCT/EP1999/005917
Authority: WO
Inventors: Kari Richter
Original assignee: Kari Richter
Priority date: 1998-08-17
Filing date: 1999-08-16
Publication date: 2000-02-24

Abstract

The invention relates to medical ultrasound apparatuses and/or combined ultrasound-radiography apparatuses for examining the human breast. According to the invention, an ultrasound applicator (14) which is surrounded by ultrasonic coupling fluid (23) in a liquid-tight manner is arranged such that it can be displaced along a distance in and/or on at least one compression plate (2, 4) which is also arranged such that it can be displaced. Ultrasonic coupling fluid which is distributed in a perfectly homogeneous manner with regard to the layer thickness and which has a maximal layer thickness equal to the height of the ultrasonic transducer elements (15) is located in the beam path in order to carry out the radiography examination in a manner which is independent of the direction of projection of the X-ray radiation in relation to the human breast, and/or the ultrasonic coupling fluid is completely removed from the beam path for carrying out the radiography examination.

Description

Combined ultrasound x-ray machines

description

The invention relates to medical ultrasound examination devices and / or combined ultrasound X-ray devices with at least one movably arranged compression plate, in a special embodiment a combined ultrasound X-ray examination device with two compression bodies arranged opposite and movable relative to one another, between which there is an examination room and for what purpose Both cases include ultrasound applicators which are movably arranged along a route and which can be completely removed from the beam path in order to carry out the X-ray examination. The invention also relates to a medical examination device with at least one movably arranged compression plate, which has an interior space filled with ultrasound coupling fluid, in which an ultrasound transducer arrangement is arranged to be movable along a straight line. In a first embodiment, the ultrasound coupling fluid is left both during the x-ray examination and as a prerequisite for the ultrasound examination in the interior of the compression plate (case / variant 1 according to claim 2.1.), Both the design of the height of the interior of the compression plate and the design of the ultrasound Applicator, as well as the related ultrasonic coupling fluid ensure that the arrangement has a low X-ray absorption. In a special embodiment, the coupling fluid is completely removed from the interior of the compression plate after the ultrasound examination (case / variant 2 according to claim 2.2.). The invention further relates to an ultrasound applicator, which is located in the interior of a housing on a compression plate, the housing having an opening in a sound path emanating from the ultrasound applicator (case / variant 3 according to claim 2.3.). The field of application is the combined X-ray and ultrasound examination in mammography and ultrasound echography.

A medical ultrasound examination device is known from Japanese Patent Application Laid-Open 60-190853. The examination device is intended for the ultrasound examination of the female breast. It comprises two compression plates which are arranged so as to be movable relative to one another and which are designed to fix and compress the breast. In a first embodiment, both compression plates have an interior, in which an ultrasound transducer arrangement is arranged movably in an ultrasound coupling fluid on the opposite side. One of the transducer arrangements is designed to transmit and receive ultrasound signals. The second ultrasonic transducer arrangement is only intended for reception. In a further embodiment, an ultrasound transducer arrangement is arranged movably in one direction of movement only in one of the compression plates. The ultrasound transducer arrangement comprises a plurality of ultrasound transducer elements arranged in series. The ultrasound transducer arrangement is connected to an evaluation unit that extracts information about the internal structure of the area to be examined from the received signals. This information is displayed on a monitor connected to the evaluation circuit. Because the transducer arrangement is in the coupling fluid, a good acoustic coupling of the ultrasound transducer arrangement to the compression plate is ensured. The description of how the mechanical drive of the ultrasonic transducer arrangement is designed leaves open. This device should only be used for an ultrasound examination. The layer thickness of the housing is therefore irrelevant. However, it is not intended to remove the liquid between the individual examinations, which is also not necessary for an exclusive ultrasound examination. US Pat. No. 4,681,120 reports on the filling and partial emptying of a container into which the breast is placed for the exclusive ultrasound examination, in that the aim is to balance differently large breast volumes in the examination room. For this reason, complete emptying of the container is not provided, and the container is also not a compression plate. Since it is not intended to completely empty the container, no means are provided which, in addition to pumping off the liquid, are also intended to remove any remaining liquid residues. In the publication by A. Hernandez et al. (Acquisition and Steroscopic Visualization of Three-Dimensional Ultrasonic Breast Data, in LEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control, Vol. 43, 1996, pp. 576-80), the movement of the transducer in a closed housing is achieved by means of Rod and gearwheel described. The drive device is located on the compression plate. However, the solution described cannot be used to move the transducer within a compression plate. A combined ultrasound-X-ray examination device of the type mentioned is known from DE-OS 4309597. The combined ultrasound-x-ray examination device described there is designed for examining the female breast and has two compression plates which can be moved relative to one another and with which the breast can be compressed and fixed. An X-ray tube placed above the compression plates can expose a film placed on the lower compression plate to record conventional X-ray mammograms. In addition, ultrasound information from the fixed breast are generated on the basis of echo signals. For this purpose, an ultrasound applicator (also referred to as an ultrasound transducer, ultrasound transducer arrangement or transducer) is movably arranged in a carriage via a guide system on the upper compression plate, that is to say the compression plate that faces the x-ray tube. The carriage is moved manually or stepper motor driven on the compression plate in order to scan the entire examination area with ultrasound waves. The ultrasound applicator must be coupled sound-wise to the surface of the compression plate, otherwise undesirable echo signals are generated which cause image artifacts. The examination of the compressed breast by X-ray and ultrasound is described in the document FR 2733142 AI. A disadvantage of both of the inventions described is that it is not carried out exactly how the applicator is coupled to the compression plate, or no means are provided which completely remove the coupling agent after the ultrasound examination so that it does not interfere with the X-ray examination. In US Pat. No. 5,479,927 it has been proposed in a combined ultrasound-X-ray examination device to improve the acoustic coupling of the ultrasound transducer array that either a suitable coupling agent is used or that the surface of the compression plate is covered with an additional thin gel pad. Since the coupling agent is located in the beam path between the X-ray tube and the film, an undesirable image on the mammogram can be expected due to an unavoidable uneven distribution. In addition, intermediate layers for the X-rays act like filters, which can cause undesired hardening of the X-ray. In ultrasound examinations of the female breast, two possibilities for the sound coupling of an ultrasound applicator are known. On the one hand, the ultrasound applicator can optionally be coupled directly to the skin surface using an ultrasound coupling means, on the other hand, in certain examinations, the ultrasound applicator is indirectly coupled via an ultrasound-permeable compression plate, and an ultrasound coupling means is also generally used here. A device for indirect coupling of the ultrasound applicator is known from US Pat. No. 5,603,326. In particular in the case of a combined x-ray-ultrasound examination of the female breast, the ultrasound applicator is not coupled directly to the surface of the skin but via the compression plate.

An ultrasonic applicator is the subject of the above-mentioned US Pat. No. 5,479,927. The ultrasound applicator there comprises a device with which a sliding / coupling means is applied between the ultrasound applicator and the surface of the compression plate can be. The ultrasound applicator comprises an ultrasound transducer provided with a housing. Spacers are formed in the housing at the lower end. A space free of housing walls is thus created between the individual spacer elements. The spacer elements raise the contact surface of the ultrasonic transducer and the housing somewhat from the surface of the compression plate. The interior of the housing is filled with a sponge-like material that is soaked in a suitable lubricant / coupling fluid. In use, the spacers and the sponge-like material are in contact with the compression plate. In this way a thin film of lubricant / coupling agent is applied to the plate. The housing also allows the ultrasound applicator to be handled without touching the sponge-like material. The lubricant / coupling agent remains on the surface of the compression plate with this feed. This layer can lead to artifacts in an X-ray mammogram that is subsequently created. This is because it cannot be assumed that the layer of lubricant / coupling agent is distributed uniformly thick on the compression plate, as a result of which the X-ray radiation is absorbed to different extents depending on the thickness of the lubricant / coupling agent.

In the patent application DE 3733439 AI, a device for the removal of superficial organs from the transducer is described, since older ultrasound devices had resolution problems in the close range (which was overcome in newer devices) and as a result it was not possible to display structures close to the transducer. The container represents an artificial layer of tissue (so-called lead section). Continuous scanning of the compressed breast on a compression plate is not possible with such a device.

The invention is based on the objects of developing the medical examination devices mentioned at the outset such that the ultrasound transducer arrangement can be moved precisely in or on the compression plate (s) with the least possible mechanical outlay, to specify a combined ultrasound-X-ray examination device, the ultrasound transducer arrangement being well coupled to the compression body, but at the same time preventing the x-ray mammogram from being impaired by the ultrasound coupling fluid, and developing an associated ultrasound applicator which, on the one hand, can be coupled ultrasonically to a surface and, on the other hand, does not Artifacts caused by the lubricant / coupling agent generated in the X-ray mammogram. The problem was solved on the one hand in that in medical ultrasound examination devices with movably arranged compression plates (2, 4), ultrasound coupling fluid and with a moveable ultrasound arranged along a route. Applicator (14) at least one of the movably arranged compression plates (2) has a liquid-tight interior (12) filled with ultrasound coupling liquid (23) from the height of the sound elements of the ultrasound applicator (14), in which the ultrasound applicator (14) is located, which is connected to a rod connected to a drive (25) in which the electrical cables (31) of the ultrasound applicator (14) are guided from the interior in a liquid-tight manner. During the X-ray examination, the ultrasound applicator is removed from the beam path, while the interior of the compression plate remains completely and in a uniform layer thickness filled by the coupling liquid. Here, the minimization of the height of the interior of the compression plate to the height of the sound elements by lateral guidance of the electrical lines realizes the lowest possible X-ray absorption of the coupling liquid, which is not removable during the X-ray examination, and which also has a low X-ray absorption due to its chemical composition. The ultrasound examination device can thus be used as a combined ultrasound-X-ray examination device. On the other hand, the object was achieved in that in a combined ultrasound X-ray examination device with two compression bodies (2, 4) arranged opposite one another and movable relative to one another, between which there is an examination space, one of the compression plates (2) has an interior (12 ), in which the ultrasound transducer arrangement connected to a drive is arranged, means (32, 34, 36, 40) for filling the interior (12) with ultrasound coupling fluid (23) and for removing ultrasound coupling fluid (23) are present from the interior (12) and that the ultrasound applicator (14) can be completely removed from the beam path after the ultrasound examination, as in the case of variants 1 and 3. In variant 1 according to the invention - and only in this - the coupling agent is not removed during the X-ray examination. For this reason, coupling liquids such as oils or alcohols are suitable as coupling liquids, but also any other liquid with low X-ray absorption that permits ultrasonic coupling. Mineral oils, in particular light mineral oil, are suitable as oils, and alcohols, for example ethanol or propanol. In the event that the devices (coupling fluid, additional structures to implement the coupling) cannot be removed from the beam path, all measures are aimed at ensuring that the arrangement is as thin as possible in order not to stop the X-ray radiation too strongly. In the case in which the coupling fluid can be removed from the compression plate, the interior with the ultrasonic coupling fluid is used to create the ultrasound images filled. The ultrasound applicator is thus well coupled to the compression plate in terms of sound. Before the X-ray mammogram is created, the coupling liquid is removed from the interior. This avoids image artifacts (eg hardening) in the X-ray mammogram due to coupling agents. In an advantageous embodiment, a wiping element is connected to the ultrasound applicator. The wiping element removes residues of coupling liquid on the surface of the interior by moving the ultrasound applicator back into a rest position after removing the coupling liquid from the interior. As with all other variants 1 to 3, the rest position is outside the area that can be represented by X-ray.

A particularly advantageous embodiment is characterized in that the interior has a uniform cross-section in the direction of movement of the ultrasound applicator, and that a slide is connected to the ultrasound applicator, which lies sealingly on the inner surfaces which limit the cross-section. On the one hand, the slide cleans the inner walls delimiting the interior, on the other hand the slide can act as a piston to fill and empty the interior or at least support it.

In a further advantageous embodiment, a wall of the compression plate facing away from the examination space and delimiting the interior is designed to be removable or foldable. After the interior has been emptied, the wall is folded down for the X-ray examination in order to further reduce the layer thickness between the X-ray tube and the actual examination object. This would mean that the mammography constellation used up to now in X-rays would be completely unchanged despite ultrasound coupling. This solution can be used particularly effectively if the compression plate is vertical (with the mammography device lying down), filled with liquid from below, with the ultrasound applicator moving with the liquid level upwards. Because of the gravity and the liquid level, which is regulated by the pumps, the housing does not have to be tight at the top, which facilitates the folding down of the second part of the compression plate after removal of the ultrasound applicator and the coupling liquid. Surprisingly, it has been found that the ultrasound applicator can be moved precisely in the compression plate with little mechanical effort and an impairment of the X-ray mammogram by ultrasound coupling fluid was avoided by roughly removing the coupling fluid after the ultrasound examination and before performing the X-ray examination and remaining drops are also removed, at least converted into a uniform liquid film. According to the invention, in case 2 the complete removal is sought, while in case of 1 the uniform layer thickness of the coupling agent in the cavity of the compression plate no falsification of the X-ray image occurs

Only in the case of variant 1, it is imperative to make the arrangement as flat as possible, with 2 it could also be less flat, since the coupling means is completely removed. It is only advantageous here as well to keep the double-walled compression plate as flat as possible, since otherwise an unnecessarily large amount of liquid has to be moved during filling and emptying.

In variants 1 and 2, the coupling of the ultrasound applicator to the compression plate is achieved in that the latter has a cavity filled with liquid for the ultrasound examination.

According to the invention, the rod, which, in addition to the drive for scanning the examination area, serves to reliably guide the ultrasound applicator within the compression plate, and the ultrasound applicator lie essentially in one plane. This allows the upper and lower walls of the compression plate to approach each other to a maximum, so that the compression plate can be made flat. In particular when used in a combined ultrasound-x-ray examination device, the influence of the ultrasound coupling means on the x-ray imaging is minimized.

An advantageous embodiment of the invention is characterized in that the rod is designed as a hollow rod and that electrical lines connected to the ultrasound applicator are led out of the compression plate through the hollow rod. The drive thus also serves for the liquid-tight routing of the electrical lines that are required to operate the ultrasound applicator.

In a further advantageous embodiment, the ultrasound applicator is designed as an ultrasound array with a plurality of ultrasound transducer elements arranged in series. In this way, one section plane can be completely scanned ultrasonically in a single position of the ultrasound array.

In a further advantageous embodiment, the ultrasound array fills the interior transverse to the direction of movement. On the one hand, this enables ultrasound scanning up to the edge of the compression plate, and on the other hand the side walls of the interior can serve as a guide for the ultrasound applicator.

In the case of variant 3, the ultrasound applicator according to the invention is located in a housing and is moved together with it on the side of a compression plate without a cavity that is away from the patient. Between the sound window of the applicator and the compression plate there is only the coupling liquid - as in cases 1 and 2 as well - and no additional layer that is part of the housing. The Design of the housing in the area that is in direct contact with the compression plate ensures on the one hand a seal that keeps the coupling fluid inside the housing, the possibility of movement of the ultrasound applicator and housing on the compression plate and on the other hand the complete removal of the coupling agent from the compression plate in the areas over which the applicator has already moved. When using the ultrasound applicator, the sealants ensure that the lubricant / coupling agent introduced into the housing remains in the housing and cannot leak out, and thus connects the ultrasound transducer arrangement to the surface in sound. At the same time, however, it is prevented that when the ultrasound applicator moves over the surface, sliding / coupling means remain on the surface. The liquid sealants on the one hand seal the interior, but on the other hand also allow the ultrasound applicator to slide on the surface.

According to an advantageous embodiment, sliding on the surface is facilitated if the liquid sealing means additionally comprise a textile-like material. Another advantageous embodiment is characterized in that the liquid sealing means comprise rollers made of an elastic material. The rollers are arranged to further facilitate the movement of the ultrasound applicator in two opposite directions. A further advantageous embodiment is characterized in that a wiping element is attached to the housing, which can be activated in a first movement of the ultrasound applicator and deactivated in a second direction of movement. This ensures that the sliding / coupling medium is removed as far as possible after the examination. In the phase of ultrasound imaging, the wiping element is deactivated; when the ultrasound applicator moves back into a starting or rest position, the wiping element is activated, as a result of which the sliding / coupling means is then removed from the surface again.

According to a further advantageous embodiment, means for drying the surface are arranged on the housing, which can be activated in a first direction of movement of the ultrasound applicator and deactivated in a second direction of movement. The drying agents are used in addition to the wiping element to completely dry the surface,

Another advantageous embodiment is characterized in that a tightly closable liquid filling opening is arranged in the housing. Used lubricant / coupling fluid can be refilled with this. According to a further advantageous embodiment, a tightly closable Right ventilation opening arranged.

A further advantageous embodiment is characterized in that means for pressing the liquid sealing means sealing the opening against the surface to be coupled are connected to the housing. The means for pressing the liquid sealing means onto the surface to be coupled can additionally be designed in such a way that the ultrasound applicator can be guided over the surface.

In a further advantageous embodiment with the compression plates in a vertical position (in the case of a lying mammography device), in analogy to the design of the double-walled compression plate in variant 2, the upper wall of the housing surrounding the applicator and filled with coupling fluid can be dispensed with, since here a seal is provided by the Gravity is achieved by adjusting a horizontal liquid level following gravity. The coupling liquid still completely fills the housing containing the transducer and is sealed on three sides with respect to the compression plate in the manner described above by liquid sealants. On the fourth side pointing upwards, a horizontal liquid level is created by gravity, the coupling liquid fills the housing up to the boundary of the vertical walls of the housing close to the chest wall. By dispensing with sealants in the area of the open side of the housing facing the chest wall, the tissue near the chest wall can be displayed even better. The devices according to variants 1 to 3 ensure that the coupling of the ultrasound applicator is achieved by means of a liquid on the side of the compression plate facing away from the patient. For this purpose, the ultrasound applicator must be able to move so that it can scan the area and be removed from the imaging area after the examination so as not to overlay the x-ray image. According to variant 1, the problem is solved in that the coupling liquid is evenly distributed through the uniformly high interior of the compression plate, while in cases 2 and 3 the coupling liquid is completely removed before the X-ray examination. It is imperative that the coupling liquid is not in the least unevenly distributed on the compression plate, otherwise it will lead to a disturbance of the X-ray image. Even the smallest drops could lead to falsification of the X-ray image, since the low-energy mammography radiation can represent the smallest differences in density. With the devices of variants 1 to 3 according to the invention, an ultrasound image is produced up to the edge of the edge of the compression plate facing the patient, so that the areas of the chest near the chest wall are also shown. The devices according to the invention do not lead to a dead space in this area of the compression plate. The devices are capable of working in all usual mammography recording angles (craniocaudale, mediolateral and mediolateral-oblique projection) and thus in all spatial directions. In all three variants, only the coupling medium and no additional intermediate layers are located between the sound window of the ultrasound applicator and the side of the compression plate facing away from the patient, since these absorb sound energy and would interfere with the ultrasound image.

The space between the sound window of the ultrasound applicator and the compression plate was ideally kept as small as possible, since a larger layer thickness of the coupling agent would lead to sound losses and a reduction in the imaging area of the breast. A capillary layer of the coupling means between the sound window and the compression plate is completely sufficient for the purpose of coupling and was ensured with the present invention. The display window of the ultrasound applicator moves as close as possible over the patient-facing surface of the wall of the double-walled compression plate (cases 1 and 2) or the side of the normal compression plate (case 3) facing away from the patient for optimal image generation.

The essence of the invention lies in the development of an ultrasound device and / or combined ultrasound X-ray device for examining the human breast with at least one movably arranged compression plate, in and / or on which an ultrasound applicator, which is surrounded by ultrasound coupling liquid in a liquid-tight manner, is movably arranged along a distance is. In order to carry out the X-ray examination, regardless of the direction of projection of the X-rays with respect to the human breast with respect to the layer thickness, a completely uniform distribution of the ultrasound coupling fluid with a maximum layer thickness of the height of the ultrasound transducer elements in the beam path is achieved and / or the ultrasound coupling fluid Carrying out the X-ray examination completely removed from the beam path. The devices according to the invention are that

- In a combined ultrasound-X-ray examination device, at least one of the movably arranged compression plates has a liquid-tight interior (12) filled with ultrasound coupling liquid, from the height of the sound elements (15) of the ultrasound applicator. It contains the ultrasound applicator, which is connected to a rod (7) which is connected to a drive (25) and in which the electrical cables of the ultrasound transducer elements (15) are guided in a liquid-tight manner from the interior and the ultrasound applicator the ultrasound examination can be completely removed from the beam path; - In a combined ultrasound-X-ray examination device with two opposite and compression bodies (2, 4) arranged to be movable relative to one another, between which there is an examination room, one of the compression plates has an interior (12), in which the ultrasound applicator (14) connected to a drive (25) is arranged. Means (32, 34, 36, 40) are available for filling the interior with ultrasonic coupling fluid (23) and for removing ultrasonic coupling fluid from the interior. The ultrasound applicator (14) can be completely removed from the beam path after the ultrasound examination;

- The ultrasound coupling fluid (23) and the ultrasound applicator (14) are in a housing (13) on the side of a compression plate (2) facing away from the patient, which contains an opening (1 1) in the area of the sound path. The opening is surrounded by liquid sealing means (37, 49, 50, 51) for sealing the interior of the housing (9) against a surface (39) to be coupled ultrasonically, the liquid sealing means simultaneously moving the ultrasound applicator (14) and housing on the Allow surface (39) to be coupled ultrasonically for the continuous generation of ultrasound sectional images and for the complete removal of the transducer and housing for carrying out the X-ray examination.

The examination device according to variant 1 consists in that the height of the interior (12) of the compression plate (2) is limited to the height of the ultrasound transducer elements (15) of the ultrasound applicator (14) in order to minimize the x-ray absorption. By routing the electrical cables of the ultrasound transducer (15) vertically in relation to the sound path, the rod (7) and the ultrasound applicator (14) are arranged essentially in one plane. The rod (7) acts as a straight and rigid hollow rod through which an electrical line (31) connected to the ultrasound transducer elements (15) is led out of the compression plate (2). The ultrasound applicator (14) is designed as an ultrasound array (5) with a plurality of ultrasound transducer elements (15) arranged in a row, the ultrasound array (5) filling the interior (12) transversely to the straight line. The compression plate (2) and the interior (12) are rectangular. The drive device (25) for moving the ultrasound applicator (14) is located inside or outside the double-walled compression plate in the middle or outside of the coupling liquid. Oils, such as mineral oil or light mineral oil, and alcohols, such as ethyl alcohol or propyl alcohol, are used as coupling liquids with a low X-ray absorption.

The essence of the examination device according to variant 2 is that the compression plate (2) is equipped with an interior (12) in which the ultrasound applicator (14) moves. The coupling liquid (23) is completely removed after the examination, in addition to pumping out, additional means (32, 34, 36, 40) are also used to remove the last liquid residues. The interior (12) of the compression plate (2) can be opened and one of the plates forming the interior - the second plate facing away from the patient, which is the same size as the actual compression plate - can be removed from the beam path after removal of the coupling liquid. The double-walled compression plate (2) is vertical when the mammography device is lying down. It is filled with liquid from below, the ultrasound applicator (14) moving with the liquid level upwards. The interior (12), which is open at the top, makes it easier to fold down the second part of the compression plate after removing the transducer (14) and the coupling fluid (23) after the ultrasound applicator has moved back to the starting position and the coupling fluid has been completely removed. The drive device (25) for moving the ultrasound applicator (14) can be located in the interior of the double-walled compression plate (2) in the middle of the coupling liquid (23). The rod (7) containing the electrical lines (31) of the ultrasound applicator is guided out and in liquid-tight from the interior (12) during a movement. The drive (25) can also be located outside the double-walled compression plate (2). The means (32, 34, 36, 40) are available for filling the interior (12) with ultrasonic coupling fluid (23) and for removing ultrasonic coupling fluid from the interior. The compression bodies (2, 4) are designed as flat plates that are parallel to each other. The ultrasound applicator (14) comprises a plurality of ultrasound transducer elements (15) arranged in a row. A slide (40) can be connected to the ultrasound applicator (14). The interior (12) has a ventilation opening (38) and a uniform cross section in the direction of movement of the ultrasound applicator (14). The slide (40) connected to the ultrasound applicator (14) lies sealingly against the inner walls that limit the cross section. The means for filling and emptying comprise a storage container (36) with a liquid transport device, the storage container (36) being connected to the interior (12) via a liquid line (32). A wall (46) of the compression plate (2) facing away from the examination space and delimiting the interior (12) is designed to be removable or foldable. The essence of the examination device according to variant 3 is that the housing (13) has an opening (11) in a sound path emanating from the ultrasound applicator (14). The opening of the housing that opens the sound path of the ultrasound applicator is surrounded by liquid sealing means (49, 51, 37) for sealing the interior of the housing (9) of the housing containing the ultrasound applicator from a surface (39) to be coupled with ultrasound. The ultrasound applicator (14) is located in a housing and is moved together with this on the side of the compression plate facing away from the patient. Only the coupling fluid is located between the sound path of the applicator and the compression plate. The design of the housing in the area that is in direct contact with the compression plate is, on the one hand, by a seal (37) that keeps the coupling fluid inside the housing and by the possibility of movement of the ultrasound applicator and housing on the compression plate and, on the other hand, by ensures the complete removal of the coupling agent from the compression plate in the areas over which the ultrasound applicator has already moved. The examination device with ultrasound applicator (14) according to variant 3 contains liquid sealants (49, 51, 37) which are designed for coupling to a flat surface (39). They additionally comprise a textile-like material and rollers (49) made of an elastic material. The housing (13) comprises two parallel long sides and transverse sides connecting the long sides. The liquid sealing means consist of two rollers (49) which are arranged on the long sides and of sealing pieces (51) on the transverse sides between the rollers, the sealing pieces (51) sealingly covering the rollers (49) on the side. A wiping element (52) is fastened to the housing (13) and can be activated in a first direction of movement of the ultrasound applicator (14) and deactivated in a second direction of movement and is arranged on a long side. Also arranged on the housing (13) are means for drying (53) the surface (39), which can be activated in a first direction of movement of the ultrasound applicator (14), deactivated in a second direction of movement and are arranged on a long side. They comprise an absorbent material, a textile material, an elastic foam material, a carrier element (54) - the carrier element being designed to replace the absorbent material - and a heating element (55). A tightly closable liquid filling opening (45) and a ventilation opening (47) are arranged in the housing (13). The surface (39) to be coupled is connected to the housing (13) by means of pressing (41, 44, 50) the liquid sealing means (49, 51) sealing the opening (11). In a further embodiment of the examination device with an ultrasound applicator (14), the housing (13) has an opening (11) in the direction of the sound path and an opening in a sound path emanating from the ultrasound applicator (14) when the radiation and reception direction of the ultrasound waves are horizontal (65).

The ultrasound applicator (14) according to the invention is provided in this further embodiment for coupling when the compression plate is vertical. It is characterized by the fact that in an interior (9) there is one except the opening (11) and the opening (65) tight housing (13) is arranged and firmly connected to the housing (13), the opening (11) in the sound path of one generated by the ultrasound applicator (14) in the case of transmission or one by the ultrasound applicator (14 ) sound wave to be received. The ultrasound applicator (14) comprises a plurality of transducer elements (15) arranged in a row, which can be activated individually. The housing (13) is designed in the form of a rectangular box that is open on both sides. On the three edges of the housing (13) delimiting the opening (1 1), a seal (37) is placed all around on an outer surface (39) of a compression plate (2), the opening (1 1) pointing sideways in use, while the opening (65) faces upwards. When the ultrasound applicator (14) is moved out of the imaging area before an X-ray examination is carried out, residues of the coupling liquid are removed by activated wiping elements (52) and drying means (53) which are located in the region of the opening (65). If the ultrasonic applicator (14) is also horizontally guided on the vertical compression plate (2), the opening (65) is formed by dispensing with one of the narrow walls of the housing.

The use of the medical ultrasound device and / or combined ultrasound X-ray device according to the invention lies in the examination of the human breast, the use of the ultrasound applicators (14) in medical ultrasound devices and / or combined ultrasound X-ray devices. In addition to the claims, the features of the invention also emerge from the description, the individual features representing advantageous protective designs, individually or in combination in the form of combinations, for which protection is requested with this document. The combination consists of known (combined ultrasound X-ray device, ultrasound applicator) and new elements (low height of the compression plate, coupling agent with low X-ray absorption, complete removal of the coupling agent, ultrasound applicator with sealants), which influence each other and in theirs result in a new overall effect and the desired success, which lies in the fact that now a combined ultrasound-X-ray examination is made possible by minimizing the X-ray absorption of the structures necessary for the ultrasound coupling, that by means of the completely uniform distribution of the coupling agent with respect to the layer thickness or its complete removal during the X-ray examination an X-ray examination is possible without falsifying the X-ray image and nevertheless a good ultrasound coupling is guaranteed. The combination also extends to the cases / variants 1 to 3 mentioned in the description and to claims 2.1. until 2.3 .. The invention is to be explained in more detail on the basis of exemplary embodiments, without being restricted to these examples.

embodiments

Example 1: Medical examination device. FIG. 1 shows a perspective view of a first embodiment of a medical examination device with two compression plates, a drive for an ultrasound applicator being arranged outside a compression plate and

2 shows a perspective view of a second embodiment of a medical examination device, the drive being arranged within a compression plate. 1 shows a perspective view of a medical examination device for breast examinations with two compression plates (2, 4) arranged parallel and movable to one another. The mechanism for adjusting the compression plates (2, 4) is not specified here for reasons of clarity, only double arrows (56) symbolize a corresponding adjustment and setting option. Alternatively, one of the compression plates, e.g. B. the compression plate (4), also be arranged stationary. Correspondingly, a body part to be examined is then compressed and fixed only by adjusting the compression plate (2).

The compression plate (2) has a rectangular interior (12), in which an ultrasound transducer array (5) is arranged. The ultrasound wander array (5) is arranged in the interior (12) to be movable back and forth along a straight path, which is illustrated by a double arrow (57). The ultrasound transducer array (5) comprises a plurality of ultrasound transducer elements (15) which are arranged in a row transversely to the direction of movement (57) and extend as far as the opposite side walls (17) of the interior (12). The ultrasound applicator (14) is connected via a holder (19) to a hollow rod (7) which is straight here and which is sufficiently rigid for a continuous movement of the ultrasound transducer array (5). The hollow rod (7) is guided out of the compression plate (2) via a seal (3) and guide (41). The hollow rod (7) is aligned parallel to the movement path of the ultrasound transducer array (5) and lies essentially in one plane with the ultrasound transducer array (5). The interior (12) is equipped with an ultrasound Coupling fluid for ultrasonic coupling of the individual ultrasonic transducer elements (15) to the underside of the compression plate (2) completely filled. The hollow rod (7) is connected to a mechanical drive which causes the rod (7) to move back and forth (double arrow 29) with appropriate control. For example, a forward movement away from the drive (25) can be carried out step by step to create a sequence of sectional images arranged parallel to one another and the return to a rest position can take place continuously. When the sectional images are created, the distance covered by the ultrasound transducer array (5) is registered in order to be able to assign the individual cuts to one another. For this purpose, the movement steps of the motor are recorded by a control element.

Electrical connection lines (31) required for the operation of the ultrasonic transducer elements (15) are, starting from the ultrasonic transducer elements (15), through the interior of the hollow rod (7) from the interior (12) of the compression plate (2) to an evaluation unit (33 ) guided. The evaluation unit (33) comprises the functional units of a conventional ultrasound diagnostic device, such as, for. B. ultrasonic transmitter, ultrasonic receiver and processing circuit for generating on a monitor (35) representable image signals.

If, as in DE-OS 4309597, already cited at the beginning, the medical examination device is additionally equipped with an X-ray source and an X-ray detector for generating X-ray images of the body part to be examined, then the compression plate (2) is caused to prevent hardening in the X-ray image through the filter effect of the coupling liquid, designed as flat as possible. In this case, the interior (12) is only slightly higher than the ultrasound transducer array (5). The free cross section only has to be large enough that the coupling liquid can be displaced without great resistance during the movement of the ultrasound transducer array (5).

In the embodiment of the compression plate (2) shown in FIG. 2 with the ultrasound transducer array (5), a toothed rack (7A) is connected to the ultrasound transducer array (5). The drive in the direction of movement (57) takes place via an electric motor (25A) arranged in the compression plate (2). A gearwheel (63) which engages in the toothed rack (7A) is fastened to a shaft of the electric motor (25A). Connection lines of the electric motor (25A) are felt liquid-tight from the interior (12). The seal (3) is so elastic that it seals the interior (12) in a liquid-tight manner even when there is an engagement between the teeth of the toothed rack (7A). The remaining details correspond to those already described with reference to FIG. 1. Example 2: Combined ultrasound X-ray examination device

Show it:

FIG. 3 shows a schematic representation of a combined ultrasound-X-ray

Examination device with an ultrasound applicator arranged in the interior of a compression plate, the interior being able to be filled and emptied with coupling means,

FIG. 4 shows a side view in cross section of a first embodiment of the compression plate with an internal converter arrangement,

5 shows a perspective view of a second embodiment of the compression plate with an internal transducer arrangement, and FIG. 6 shows the compression plate according to FIG. 3 with the wall folded down.

FIG. 3 schematically shows the parts of a combined ultrasound / X-ray examination device that are essential for the invention, further details can be found in DE-OS 4309597 already cited at the beginning. The combined ultrasound-X-ray examination device is designed in particular for examining the human breast and comprises two compression bodies in the form of flat and uniformly thick plates (2, 4) which are arranged opposite and movable relative to one another on a tripod, not shown here. At least the upper compression plate (2) is movable with respect to the stand, which is to be illustrated by a double arrow (6). The breast (1) to be examined is positioned between the two compression plates (2, 4), the upper compression plate (2) is then moved in the direction of the second compression plate (4) until the breast (1) compresses sufficiently for an examination and is fixed. An X-ray source (8) is arranged above the upper compression plate (2). The X-radiation emitted by the X-ray source (8) passes through the upper compression plate (2) and the breast (1) to be examined and then strikes an X-ray film (10) arranged on the lower compression plate (4). Digital systems can also be used as X-ray image converters. Further details on the x-ray part of the combined ultrasound-x-ray examination device, such as, for example, anti-scatter grid, exchangeable cassettes, control for the x-ray radiation source (8), etc., correspond to those of conventional x-ray mammography devices. For reasons of clarity, they are not shown further here. The upper compression plate (2) has as a hollow body an interior (12), in which an ultrasound applicator (14) in the form of a transducer array with transducer elements (15) arranged in a row (see FIGS. 5 and 6) can be moved back and forth between the left and right side wall (16) or (18) is arranged. This back and forth movement is transverse to the row of transducer elements (15) and is symbolized by a double arrow (20). To connect the ultrasound applicator (14) to the compression plate (2), the interior (12) is filled with an ultrasound coupling fluid (23). The side (21) of the compression plate (2) facing the second compression plate (4), which also serves as a compression surface for compressing and fixing the breast, is made of an ultrasound-permeable material, so that ultrasound waves generated by the ultrasound applicator (14) are produced the coupling liquid (23) and the wall can enter the object to be examined. Reflected echo signals can also be received again by the ultrasound applicator (14). The transmission and reception direction of the ultrasonic transducer arrangement is indicated by a double arrow (22). Since the interior (12) is designed to be liquid-tight, in principle any spatial alignment of the compression plates (2, 4) is permissible.

The ultrasound transducer arrangement for the movement within the compression plate (2) is driven by a linkage (24) which is guided liquid-tight from the compression plate (2) and then connected to a motor (26). The signal lines (27) belonging to the ultrasound applicator (14) from the interior (12) to an electronics unit (28) are also felt with the linkage (24). The electronics unit (28) comprises the functional units required to operate the ultrasound device, e.g. Transmitter, receiver, signal processing, position detection of the ultrasound applicator (14) for correct spatial assignment of the ultrasound images, etc. The information contained in the echo signals is then fed to a display device (30). The functional units are described in detail in the aforementioned DE-OS 4309597, so that further explanations are not given here.

For filling and emptying the interior (12) with ultrasonic coupling means (23), a liquid line (32) opens into the interior (12) on the right side wall (18). The ultrasound coupling liquid (23) can be pumped from the interior into a storage container (36) by means of a pump (34) or vice versa from the storage container (36) into the interior (12). A ventilation opening (38) for the interior (12) facilitates the filling and emptying of the interior (12).

An X-ray mammogram is created after the ultrasound coupling fluid (23) has been removed from the interior (12) and the ultrasound applicator (14) is in a rest position on the right side wall (18). Ultrasound coupling fluid (23) which causes artifacts is removed, as is the ultrasound applicator (14), from the beam path of the X-ray source (8). Ultrasound images, whether in the form of sectional images or in the form of projection images, are created after the interior (12) is filled again with the ultrasound coupling fluid (23). Figure 4 shows the compression plate (2) in a sectional view. In one variant The ultrasound applicator (14) is connected to a slide (40), which fills the entire cross-section in a sealing manner and divides the interior (12) into two variable compartments (12A) and (12B), similar to a piston in a cylinder. The linkage (24) is designed in the form of a hollow rod, in which the signal lines (27) are laid. A seal (42) seals the partial interior (12B) on the passage of the rod (24) from the outside. Instead of the pump (34) - not shown here - the slide (40) can suck the coupling liquid (23) into the then increasing partial interior (12B) by moving towards the left side wall (16). When the ultrasound applicator (14) moves in the opposite direction in the direction of the right side wall (18), the volume of the partial interior (12B) decreases, the ultrasound coupling liquid is pressed into the storage container (36), not shown in FIG. 4. The slide (40) simultaneously cleans the inside walls of the interior (12) of residues of the ultrasonic coupling fluid (23).

The variant of the compression plate (2) with an internal ultrasound applicator (14) shown in FIGS. 5 and 6 is preferably provided for a vertical arrangement. In contrast to conventional X-ray mammography equipment, the breast is brought from above, symbolized by an arrow (44), between the compression plates (2 and 4). The liquid line (32 opens into a lower side wall of the compression plate (2). The interior (12) can thus - if necessary after opening a shut-off valve (not shown here) - with the reservoir (36) arranged lower by gravity alone and without the help of a The pump is emptied by the ultrasonic coupling fluid (23) and the interior (12) is filled with the pump (34).

In the variant shown in FIG. 6, the wall (46) facing the X-ray source (8) - not shown here - is additionally folded away, symbolized by a curved double arrow (48). The layer thickness in the beam path of the X-ray source can thus be reduced. In the closed state (FIG. 5), all-round seals ensure the liquid-tight interior (12). To remove the last traces of ultrasonic coupling fluid on the side of the compression plate (2) facing the examination room, the ultrasonic applicator (14) can be provided with a wiping element, similar to the slide (40). In the case of the horizontal arrangement of the compression plates (2 and 4) shown in principle in FIG. 3, the wall (46) can also be designed to be foldable away.

Example 3: Ultrasound applicator. FIG. 7 shows a perspective view of a first embodiment of the ultrasound Applicator with sealant,

8 shows a sectional illustration of the first embodiment,

9 shows a perspective view of a second embodiment of the ultrasound applicator with rollers, FIG. 10 shows a side view of an ultrasound applicator with a deactivated wiping element and deactivated means for drying the surface and

11 shows a side view of the ultrasound applicator according to FIG. 4 with activated wiping element and activated means for drying. 12 shows a perspective view of the ultrasound applicator with sealing means according to FIG. 7 in a vertical direction of movement.

7 shows a perspective view of a first simply constructed variant of the ultrasound applicator according to the invention. An ultrasound applicator (14) is arranged in an interior (9) of a housing (13) which is sealed except for an opening (11). The ultrasound applicator (14) is firmly connected to the housing (13), which was not shown here for reasons of clarity. The opening (11) lies in the sound path of a sound wave generated by the ultrasound applicator (14) in the case of transmission or a sound wave to be received by the ultrasound applicator (14) in the case of reception. The ultrasound applicator (14) comprises a plurality of transducer elements (15) arranged in a row, which can be activated individually. The housing (13) is designed in the form of a rectangular box open on one side. On the edges of the housing (13) delimiting the opening (11), a seal (37) made of an elastic material, for example a rubber-like material, is attached all round. In use, the ultrasound applicator with its seal (37) is placed on an outer surface (39) of a compression plate (2), here the opening (1 1) points downwards in the application. The compression plate (2) consists of an ultrasound-transparent material, so that ultrasound waves emitted by the ultrasound applicator (14) can pass through and enter an examination area which is coupled in a correspondingly sound manner via an opposite inner surface. A guide (41) is attached to a side surface of the housing (13), with which the ultrasound applicator (14) can be moved on the compression plate (2) transversely to the arrangement of the transducer elements (15). The direction of movement back and forth on the compression plate (2) is symbolized by a double arrow (58). In addition, pressure is exerted on the guide (41) in the direction of the compression plate (2) (arrow 60), so that the seal (37), with the aid of the surface (39) of the compression plate (2), makes the interior (9) of the housing liquid-tight completes. The guide (41) is designed in the form of a rigid tube, in which electrical leads (31) for the ultrasound applicator (14) can be felt out of the interior (9). Since consumption of the coupling agent must be expected during use, the housing is additionally provided with a closable liquid filling opening (45) and a closable vent opening (47). 8 shows a sectional view of the ultrasound applicator according to FIG. 7. The emitting surface (64) of the ultrasound applicator (14) is arranged at a short distance from the outer surface (39) of the compression plate (2). This prevents the emitting surface (64), which can also be an acoustic lens, from rubbing on the surface (39) of the compression plate (2). Likewise, the distance is chosen so that coupling liquid filled in the interior (9) reliably fills the space between the radiation surface (64) and the outer surface (39). The main direction of the emitted ultrasound waves and the main sensitivity direction is symbolized by a double arrow (59). The peripheral seal (37) is provided on its contact surface with a layer (43) made of a thin textile material in order to improve the sliding properties. The textile material has openings, for example it is formed like a lattice, the openings being filled flush with the material from which the seal is made. Since consumption of the coupling agent must be expected during use, the housing is additionally provided with a closable liquid filling opening (45) and a closable vent opening (47). In the second variant of the ultrasonic applicator shown in FIG. 9 in a perspective view, rollers (49) made of an elastic material are arranged on both opposite longitudinal sides of the housing (13) as sealing elements in order to improve the sliding properties in the directions of movement. The rollers (49) form part of the seal. The rollers (49) are mounted in a tubular guide (50) which encloses the rollers (49) at an angle of somewhat greater than 180 °, as a result of which the rollers (49) are held securely in the guides (50). Sealing pieces (51) are also arranged on the transverse sides of the housing (13) connecting the long sides, which also additionally cover the rollers (49) in a laterally sealing manner. The sealing pieces (51) are constructed similarly to the seal (37) already described with reference to FIGS. 7 and 8. The distance between the rollers (49) can be such that the tubular guides with the rollers (49) protrude into the otherwise rectangular interior (9), so that the guides (50) are also next to the housing (13) for support and Attach the ultrasound applicator (14) can be used, as shown in FIGS 6 and 7. For reasons of stability, the rollers (49) can also be arranged at a greater distance from one another. Overall, the opening (1 1) to the surface (39) of the compression plate (2) is thus arranged on the long sides of the housing. Neten rollers (49) and sealing pieces (51) arranged on the transverse sides are sealed liquid-tight. The ultrasound applicator (14) is not shown in FIG. 9, but it is installed in a similar manner in the housing (13), as has already been described with reference to FIG. 10 and 11, the ultrasound applicator is additionally equipped with a wiping element (52) and means for drying (53). The wiping element (52) is arranged on one long side of the housing (13) over its entire length and, after the examination has been carried out, removes any residues of the coupling liquid remaining on the surface (39). Complete drying is achieved with the drying means (53). The drying means (53) mainly consist of an absorbent material, for example a textile material in the form of a felt or an elastic foam material.

During the execution of the ultrasound scanning, both the wiping element (52) and the means for drying (53) are pivoted away from the surface (39), as shown in FIG. 10. The movement when scanning is symbolized by an arrow (61). If the ultrasound applicator is moved back to its starting position, symbolized by an arrow (62), the wiping element (52) and the means for drying (53) are lowered onto the surface (39), so that coupling agents remaining after the examination are removed from the surface ( 39) the compression plate (2) can be removed. The activated position of the wiping element (52) and the means for drying (53) are shown in FIG. 1 1. After prolonged use, the means for drying (53) are soaked with coupling liquid. Therefore, the absorbent material is attached to a carrier element (54) in an easily replaceable manner. Alternatively, a heating element (55) can be fastened to the carrier element (54), as a result of which the soaked absorbent material can be dried again on the means for drying (53). 12 shows a perspective view of a further embodiment of the ultrasound applicator according to the invention, which is provided for coupling when the compression plate is in a vertical position. An ultrasound applicator (14) is arranged in an interior (9) of a housing (13) which is sealed except for the opening (11) and the opening (65). The ultrasound applicator (14) is firmly connected to the housing (13), which was not shown here for reasons of clarity. The opening (11) contains in the sound path a sound wave generated by the ultrasound applicator (14) in the case of transmission or a sound wave to be received by the ultrasound applicator (14) in the case of reception. The ultrasound applicator (14) comprises a plurality of transducer elements (15) arranged in a row, which can be activated individually. The housing (13) is designed in the form of a rectangular box that is open on both sides. At the three edges of the housing (13) delimiting the opening (11), a seal (37) is placed all around on an outer surface (39) of a compression plate (2), here the opening (11) points sideways in use, while the opening (65) points upwards. A double arrow (58) indicates the direction of movement of the ultrasound applicator (14). When the ultrasound applicator (14) is moved out of the imaging area before an X-ray examination is carried out, residues of the coupling liquid can be analogous to FIGS. 10 and 11 by activated wiping elements (52) and means for drying (53) which are located in the region of the opening (65) and have not been shown here for reasons of clarity. If the ultrasonic applicator (14) is also horizontally guided on the vertical compression plate (2), which is not shown here, the opening (65) is formed by dispensing with one of the narrow walls of the housing. Openings for liquid filling or venting can be dispensed with in any case, since the housing can be filled and vented through the opening (65).

Reference symbol list:

1 human mammary gland

3 seal

2.4 compression body in the form of a compression plate

5 ultrasound transducer array

6 double arrow

7 hollow rod

7A rack

8 X-ray source

9 Housing interior

10 film

11 opening

12 interior

12A.12B partial interior

13 housing

14 ultrasound applicator

15 ultrasonic transducer element

16 left side wall

17 sides wall

18 right side wall

19 bracket

20 double arrow ultrasound-permeable side

Double arrow

Ultrasonic coupling fluid

Linkage

drive

Electric motor

engine

Signal lines

Electronics unit

Double arrow

Electrical lines indicator

Liquid line

Expansion unit

pump

monitor

Storage container

poetry

Ventilation opening outer surface

pusher

guide

poetry

layer

arrow

Liquid filling opening

Wall

Air vent curved double arrow

Roll of tubular guide

Sealing pieces

Wiping element

Drying agents

Carrier element Heating element, 57 double arrow, 59 double arrow

Arrow, 62 arrow

gear

Radiation area

opening

Claims

claims

1. Ultrasound device and / or combined ultrasound X-ray device for examining the human breast with at least one movably arranged compression plate, characterized in that in and / or on at least one compression plate an ultrasound applicator, which is surrounded in a liquid-tight manner by ultrasound coupling liquid, can move along a distance is arranged, for carrying out the x-ray examination, regardless of the projection direction of the x-ray radiation with respect to the human breast, ultrasound coupling liquid with a maximum layer thickness of the height of the ultrasound transducer elements is distributed in the beam path with completely equal distribution with respect to the layer thickness and / or the ultrasound Coupling liquid for performing the X-ray examination is completely removed from the beam path.

2. Apparatus according to claim 1, characterized in that 2.1. In a combined ultrasound-X-ray examination device, at least one of the movably arranged compression plates has a liquid-tight interior (12) filled with ultrasound coupling liquid from the height of the sound elements (15) of the ultrasound applicator, in which the ultrasound applicator is located, which has a is connected to a drive (25) connected rod (7), in which the electrical cables of the ultrasonic transducer elements (15) are guided liquid-tight from the room and that the ultrasound applicator can be completely removed from the beam path after the ultrasound examination

2.2. In a combined ultrasound-X-ray examination device with two compression bodies (2, 4) arranged opposite one another and movable relative to one another, between which there is an examination space, one of the compression plates has an accommodation space (12), in which the ultrasound connected to a drive (25) -Applicator (14) is arranged that means (32, 34, 36, 40) for filling the interior with ultrasonic coupling fluid (23) and for removing ultrasonic coupling fluid from the interior are present and that the ultrasonic applicator (14 ) can be completely removed from the beam path after the ultrasound examination

2.3. the ultrasound coupling fluid (23) and the ultrasound applicator (14) are located in a housing (13) on the side of a compression plate (2) facing away from the patient, which contains an opening (11) in the area of the sound path, which is separated from liquid sealants ( 37, 49, 50, 51) for sealing off the interior of the housing (9) from a surface (39) to be coupled with ultrasound, the liquid Allow sealing means at the same time allow the ultrasound applicator (14) and housing to move on the surface (39) to be coupled ultrasonically for the continuous creation of ultrasound sectional images and for the complete removal of the transducer and housing in order to carry out the X-ray examination.

3. Examination device according to claims 1 and 2 number 2.1, characterized in that

3.1. To minimize the x-ray absorption, the height of the interior (12) of the compression plate (2) is limited to the height of the ultrasound transducer elements (15) of the ultrasound applicator (14) by vertical routing of the electrical cables of the ultrasound transducer (15) in relation to the sound path

3.2. the rod (7) and the ultrasound applicator (14) are arranged essentially in one plane and

3.3. the bar (7)

3.3.1. is designed as a hollow rod and that electrical lines (31) connected to the ultrasonic transducer arrangement (15) are led out of the compression plate (2) through the hollow rod

3.3.2. is straight and rigid

3.4. the ultrasound applicator (14) is designed as an ultrasound array (5) with a plurality of ultrasound transducer elements (15) arranged in a row 3.5. the ultrasound array (5) fills the interior (12) transversely to the straight line

3.6. the compression plate (2) and the interior (12) are rectangular

3.7. the drive device (25) for moving the ultrasound applicator (14)

3.7.1. 3.7.2 is located inside the double-walled compression plate in the middle of the coupling fluid. outside the double-walled compression plate and the coupling fluid

3.8. can be used as coupling liquids with a low X-ray absorption

3.8.1. Oils such as mineral oil or light mineral oil

3.8.2. Alcohols, such as ethyl alcohol or propyl alcohol

3.9. the height of the interior (12) of the compression plate (2), which is limited to the height of the ultrasonic transducer elements (15), allows smooth movement of the ultrasound applicator (14) and problem-free redistribution of the coupling fluid (23), in that the ultrasound applicator (14) does not fill the cross section of the interior in a sealing manner.

4. Examination device according to claims 1 and 2 number 2.2, characterized in that 4.1. the compression plate (2) is equipped with an interior (12) in which the Ultrasonic applicator (14) moves

4.2. the coupling liquid (23) is completely removed after the examination, whereby in addition to pumping out additional means (32, 34, 36, 40) are used to remove the last liquid residues 4.3. the interior (12) of the compression plate (2) is opened and one of the plates forming the interior - the second plate facing away from the patient, which is the same size as the actual compression plate - can be removed from the beam path after removal of the coupling fluid 4.4. the double-walled compression plate (2) is vertical when the mammography device is lying down, is filled with liquid from below, the ultrasound applicator (14) moving with the liquid level upwards and the interior space (12) which is open at the top, the folding down of the second part of the compression plate after removal of the transducer (14) and the coupling fluid (23), after the ultrasound applicator has moved back to the starting position and the coupling fluid has been completely removed 4.5. the drive device (25) for moving the ultrasound applicator (14) is inside the double-walled compression plate (2) in the middle of the coupling liquid (23) and the rod (7) containing the electrical lines (31) of the ultrasound applicator during a movement liquid-tight from the interior (12) out and in 4.6. the drive (25) is outside the double-walled compression plate (2) 4.7. Means (32, 34, 36, 40) are provided for filling the interior (12) with ultrasonic coupling fluid (23) and for removing ultrasonic coupling fluid from the interior

4.8. the compression bodies (2, 4) are designed as flat plates which are arranged parallel to one another 4.9. the ultrasound applicator (14) comprises a plurality of ultrasound transducer elements (15) arranged in a row

4.10. a slide (40) is connected to the ultrasound applicator (14)

4.11. the interior (12)

4.11.1. has a ventilation opening (38) 4.11.2. has a uniform cross-section in the direction of movement of the ultrasound applicator (14), that a slide (40) is connected to the ultrasound applicator (14) and bears sealingly on the cross-section-limiting inner walls

4.12. the means for filling and emptying comprise a storage container (36) with a liquid transport device, which storage container (36) is connected to the interior (12) via a liquid line (32) and

4.13. a wall (46) of the compression plate (2) facing away from the examination space and delimiting the interior (12) is designed to be removable or foldable.

5. Examination device according to claims 1 and 2 number 2.3, characterized in that 5.1. the housing (13) has an opening (11) in a sound path starting from the ultrasound applicator (14)

5.2. the opening of the housing, which opens the sound path of the ultrasound applicator, is surrounded by liquid sealing means (49, 51, 37) for sealing the housing space (9) of the housing containing the ultrasound applicator from a surface (39) to be coupled in with ultrasound

5.3. the ultrasound applicator (14) is located in a housing and is moved together with it on the side of the compression plate facing away from the patient

5.4. only the coupling fluid is located between the sound path of the applicator and the compression plate 5.5. the design of the housing in the area that is in direct contact with the compression plate ensures

5.5.1. on the one hand a seal (37) which holds the coupling fluid within the housing

5.5.2. the possibility of moving the ultrasound applicator and housing on the compression plate and 5.5.3. on the other hand, the complete removal of the coupling agent from the compression plate in the areas over which the ultrasound applicator has already moved.

6. examination device with ultrasound applicator (14) according to claims 1 and 2 number

2.3 and claim 5, characterized in that 6.1. the liquid sealant (49, 51, 37)

6.1.1. are designed for coupling to a flat surface (39)

6.1.2. additionally comprise a textile-like material

6.1.3. Include rollers (49) made of an elastic material

6.2. the housing (13) comprises two parallel longitudinal sides and transverse sides connecting the longitudinal sides, that the liquid sealing means comprise two rollers (49) which are arranged on the longitudinal sides, and that the liquid sealing means comprise sealing pieces (51) arranged on the transverse sides between the rollers

6.3. that the sealing pieces (51) laterally cover the rollers (49) in a sealing manner

6.4. that a wiping element (52) is attached to the housing (13), which 6.4.1. can be activated in a first direction of movement of the ultrasound applicator (14)

6.4.2. can be deactivated in a second direction of movement and

6.4.3. is arranged on a long side

6.5. that means for drying (53) the surface (39) are arranged on the housing (13), the 6.5.1. can be activated in a first direction of movement of the ultrasound applicator (14)

6.5.2. can be deactivated in a second direction of movement and

6.5.3. are arranged on a long side

6.5.4. comprise an absorbent material

6.5.5. include a textile material 6.5.6. comprise an elastic foam material

6.5.7. comprise a carrier element (54) and that the carrier element is designed to replace the absorbent material and

6.5.8. comprise a heating element (55)

6.6. that in the housing (13) a sealable 6.6.1. Liquid filling opening (45) is arranged

6.6.2. Vent opening (47) is arranged

6.7. that means for pressing (41, 44, 50) the liquid sealing means (49, 51) sealing the opening (11) to the surface (39) to be coupled are connected to the housing (13).

7. examination device with ultrasound applicator (14) according to claims 1, 2 number 2.3 and claims 5 and 6, characterized in that the housing (13) with horizontal radiation and reception direction of the ultrasound waves in one of the ultrasound applicator (14 ) outgoing sound path has an opening (1 1) in the direction of the sound path and an opening (65).

8. Ultrasound applicator of a medical ultrasound examination device with compression plates (2, 4) and ultrasound coupling fluid (23), the ultrasound applicator (14) being located in a housing (13) on a compression plate and the housing one Contains opening (11) in the area of a sound path, the opening is surrounded by liquid sealing means (49, 51, 37) for sealing a housing interior (9) against an ultrasonic surface (39) to be coupled.

9. Ultrasonic applicator according to claim 8, characterized in that 9.1. it is located in a housing (13) and together with this on the patient opposite side of the compression plate (2) is moved

9.2. only the coupling liquid (23) is located between the sound path of the applicator (14) and the compression plate (2)

9.3. the design of the housing (13) in the area which is in direct contact with the compression plate (2) is guaranteed

9.3.1. on the one hand a seal (37) which holds the coupling liquid (23) within the housing (13)

9.3.2. the possibility of movement of the ultrasonic applicator (14) and housing (13) on the compression plate (2) and 9.3.3. on the other hand, the complete removal of the coupling agent from the compression plate in the areas over which the ultrasound applicator has already moved.

10. Ultrasonic applicator according to claims 8 and 9, characterized in that

10.1. the liquid sealant (49, 51, 37) 10.1.1. are designed for coupling to a flat surface (39)

10.1.2. additionally comprise a textile-like material

10.1.3. Include rollers (49) made of an elastic material

10.2. the housing (13) comprises two parallel longitudinal sides and transverse sides connecting the longitudinal sides, that the liquid sealing means comprise two rollers (49) which are arranged on the longitudinal sides, and that the liquid sealing means on the transverse sides between the rollers (49) sealing pieces (51) include

10.3. that the sealing pieces (51) laterally cover the rollers (49) in a sealing manner

10.4. that a wiping element (52) is attached to the housing (13)

10.4.1. 10.4.2 can be activated in a first direction of movement of the ultrasound applicator (14). can be deactivated in a second direction of movement and 10.4.3. is arranged on a long side

10.5. that means for drying (53) the surface (39) are arranged on the housing (13), the 10.5.1. 10.5.2 can be activated in a first direction of movement of the ultrasound applicator (14). can be deactivated in a second direction of movement and

10.5.3. are arranged on a long side

10.5.4. comprise an absorbent material

10.5.5. comprise a textile material

10.5.6. comprise an elastic foam material 10.5.7. comprise a carrier element (54) and that the carrier element for exchanging the absorbent material is formed and 10.5.8. comprise a heating element (55)

10.6. that in the housing (13) a tightly closable 10.6.1. Liquid filling opening (45) is arranged 10.6.2. Vent opening (47) is arranged

10.7. that means for pressing (41, 44, 50) the liquid sealing means (49, 51) sealing the opening (11) to the surface to be coupled (39) are connected to the housing (13).

11. Ultrasonic applicator according to claims 8 to 10, which is provided in a further embodiment for coupling with a vertical compression plate and is characterized in that

11.1. it is arranged in an interior (9) of a housing (13) which is sealed except for the opening (11) and the opening (65) and is firmly connected to the housing (13) 11.2. the opening (11) lies in the sound path of a sound wave generated by the ultrasound applicator (14) in the case of transmission or a sound wave to be received by the ultrasound applicator (14) in the case of reception

11.3. the ultrasound applicator (14) comprises a plurality of transducer elements (15) arranged in a row, which can be activated individually, 11.4. the housing (13) is designed in the form of a rectangular box that is open on both sides

11.5. on the three edges of the housing (13) delimiting the opening (1), a seal (37) is placed all around on an outer surface (39) of a compression plate (2) and in this case the opening (11) points sideways in use, while the opening (65) points upwards and a double arrow (58) indicates a vertical direction of movement of the ultrasound applicator (14)

11.6. when the ultrasound applicator (14) moves from the imaging area before carrying out an X-ray examination, residues of the coupling liquid are removed by activated wiping elements (52) and means for drying (53), which are located in the region of the opening (65), and 11.7. if the ultrasound applicator (14) is also horizontally guided on the vertical compression plate (2), the opening (65) is formed by dispensing with one of the narrow walls of the housing.

12. Use of the medical ultrasound device and / or combined ultrasound-X-ray device according to claims 1 to 7 for examining the human breast.

13. Use of the ultrasound applicators according to claims 8 to 11 in medical ultrasound devices and / or combined ultrasound-X-ray devices.