Steerable ultrasound attachment for endoscope

Abstract

An ultrasonic endoscope assembly (110) has an endoscope (111) defining one or more lumens and a needle (114) that can be pushed forward from a lumen to collect a biopsy sample. An ultrasonic subassembly (120) is attached to the endoscope (111) and includes a communication cable (126) including a set of conductors having a distal end and an ultrasonic imaging head (122) connected to the distal end of the cable. Further included is an imaging head movement subassembly (140) including a conduit (148) releasably connected to the endoscope. The conduit houses a tension member (144) that is releasably connected to the imaging head (122). Thus, the imaging head movement subassembly (140) can be released from the cable and imaging head after use for disposal.

Description

[0001] This application is a divisional application of the application patent application with application number 201980035196.9, filed on April 12, 2019, and entitled “Steerable Ultrasound Attachment for an Endoscope”. TECHNICAL FIELD

[0002] The present invention is in the field of ultrasound imaging add-on devices for endoscopes. BACKGROUND

[0003] Endoscopic ultrasound has undergone rapid development and is now used for diagnosis and treatment of a variety of medical problems. Since endoscopes can reach locations in the intestinal tract closer than any skin surface, there is the opportunity to image from a closer location and use a biopsy needle to obtain tissue samples and perform a variety of treatments. But since a complete system costs over $200,000, endoscopic ultrasound systems are typically limited to large hospitals. However, endoscopes are used in physician offices, most ambulatory surgery centers, and almost all hospitals.

[0004] One type of endoscope is an upper endoscope, used to image the upper gastrointestinal tract and extract tissue samples therefrom. In this type of endoscope, if a needle is used to collect a sample, it is typically pushed straight out of the endoscope lumen in a distal direction. Other types of endoscopes are bronchoscopes, used to view air passages in the lungs, and colonoscopes, used to view the colon.

[0005] Another type of endoscope is a duodenoscope, designed to be introduced into the duodenum (upper part of the small intestine), and is typically used to perform endoscopic retrograde cholangiopancreatography (ERCP), in which the pancreas is imaged. Duodenoscopes are also used to collect biopsy tissue from various sites in the duodenum, including the bile duct. Duodenoscopes typically have a distal end that houses a light, a camera, a needle, and a needle guide, which can be tilted by the operator to control the angle at which the needle advances. While the camera and light can produce an image that can help the surgeon guide the needle to a good biopsy site, an ultrasound image, if available, can prove to be a valuable source of additional information. Ultrasound add-on devices for endoscopes have been described, but their functionality is limited because the angle of view of the imaging head cannot be adjusted.

[0006] A problem faced by practitioners in the field of endoscopy is the thorough disinfection of the endoscope between uses. Since many endoscopes, especially duodenoscopes, have a certain mechanical complexity, introducing disinfecting substances into the small spaces defined by these mechanisms poses a significant challenge. In recent years, an endoscope mechanism has been proposed that has a needle angle adjustment mechanism that can be removed and disposable, thus solving many of these problems. SUMMARY

[0007] In a first separate aspect, the present invention can take the form of a method of adding an element to a scope to create a scope with ultrasonic capabilities. The method utilizes an ultrasonic assembly that includes a multi-conductor electrical connector and a deformable neck having a proximal end and a distal end. An ultrasonic transducer head is supported by the distal end of the neck and includes an ultrasonic transducer. Also, a tension member is connected to the ultrasonic transducer head and extends to a proximal end of the scope. Finally, a set of signal paths extend from the ultrasonic transducer to the multi-conductor electrical connector. In the method, the ultrasonic assembly is attached to the scope so that the ultrasonic assembly extends along the elongated body of the scope and so that the ultrasonic transducer head is held by the neck at a location distal of the distal end of the scope and the tension member is arranged so that it extends from a proximal point of the scope to the transducer head. After the element is added to the scope, the ultrasonic transducer head can be introduced into a body cavity of a patient along with the scope and the angle can be adjusted by the tension member by pulling on the tension member to bend the neck, thereby adjusting the position of the ultrasonic transducer head, and the signal paths can be used to communicate with an imaging station, thereby allowing a user to more accurately aim the imaging head at a feature of interest. Finally, the neck defines an aperture that allows a needle to extend from a lumen of the scope through the aperture when the neck is bent by the tension member to perform a medical procedure.

[0008] In a second separate aspect, the present invention can take the form of an ultrasonic scope assembly having a scope defining one or more lumens and a needle that can be pushed forward from a lumen to collect a biopsy sample. An ultrasonic subassembly is attached to the scope and includes a communication cable including a set of signal paths and having a distal end and an ultrasonic imaging head connected to the distal end of the cable. In addition, an imaging head movement subassembly is included that includes a conduit releasably connected to the scope. The conduit houses a tension member that is releasably connected to the imaging head. Thus, the imaging head movement subassembly can be released from the scope and the imaging head after use for disposal.

[0009] In a third separate aspect, the present invention can take the form of a method of handling a scope assembly between uses, where each scope assembly includes a scope, an ultrasonic subassembly including a communication cable connected to an ultrasonic imaging head, and an imaging head movement subassembly. After surgical use, the imaging head movement subassembly is removed and disposed of, and the ultrasonic subassembly is removed and cleaned and the scope is cleaned, thereby creating a cleaned scope. Prior to use, the cleaned ultrasonic subassembly is retrieved and placed on the cleaned scope. In addition, a clean package containing a never used imaging head movement subassembly is opened and the never used imaging head movement subassembly is attached to the scope and the ultrasonic subassembly, thereby combining the scope, the ultrasonic subassembly, and the imaging head movement subassembly together.

[0010] In a fourth separate aspect, the invention can take the form of an endoscopic attachment suitable for attachment to a target endoscope. This attachment includes: an ultrasound imaging subassembly including a communication cable connected to an ultrasound imaging head; and an imaging head movement subassembly including a conduit that holds a tension member attached to the ultrasound imaging head. Connecting elements are also included, adapted to allow the endoscopic attachment to the target endoscope. Finally, the imaging head movement subassembly is detachable from the ultrasound imaging subassembly, thereby allowing the imaging head movement subassembly to be disposed of separately from the ultrasound imaging subassembly after use.

[0011] In a fifth separate aspect, the invention can take the form of a method for adjusting the viewing angle of an imaging assembly having an endoscope and an additional ultrasound imaging array. The array is part of an ultrasound assembly comprising: a multi-signal path connector; a multi-signal path cable having a distal end to which an endoscope attachment element is attached, and also to the distal end of the endoscope; a neck connected to and extending distally from the distal end of the multi-signal path cable, and having a distal end capable of elastic deformation; an ultrasound transducer head including a protective cover supported by the distal end of the neck and an ultrasound transducer internal to the protective cover and electrically connected to the distal end of the multi-signal path cable; and a tension member connected to the ultrasound transducer head and extending to the proximal end of the endoscope, allowing a human operator access to the free end of the tension member. Once the multi-signal path connector has been connected to the ultrasound imaging station and the ultrasound transducer head has been introduced into the patient's body cavity using an endoscope, the method begins and includes pulling the free end of the tension member to move the ultrasound transducer head from a position aligned with the distal end of the endoscope to a position bent at an obtuse angle relative to the distal end of the endoscope, and allowing the free end to retract toward the lumen, thereby allowing the ultrasound transducer head to move rearward toward a position aligned with the distal end of the endoscope, thereby scanning a portion of the patient's internal organs. Attached Figure Description

[0012] Exemplary embodiments are illustrated in the accompanying drawings. The embodiments and drawings disclosed herein are intended to be illustrative rather than restrictive.

[0013] Figure 1 This is an isometric view of an imaging assembly having an endoscope and an ultrasound imaging component attached thereto, according to a preferred embodiment of the present invention.

[0014] Figure 2 yes Figure 1 Axonometric view of the far end of the component.

[0015] Figure 3 It is in the first position. Figure 1 The far-end side view of the component.

[0016] Figure 4 It is in the second position. Figure 1 The far-end side view of the component.

[0017] Figure 5 This is a side view of the distal end of an alternative embodiment of the imaging component.

[0018] Figure 6 This is a side view of another alternative embodiment of the imaging component.

[0019] Figure 7 This is an alternative embodiment of an imaging assembly having an ultrasound imaging sub-assembly including a detachable ultrasound head movement assembly, and three needle guides are shown.

[0020] Figure 8 yes Figure 7 A cross-sectional view of the component shows the needle guide in its deployment state.

[0021] Figure 9 is Figure 7 A detailed drawing of a component, showing two parts separated from each other.

[0022] Figure 10 is a detailed view of Figure 9, but shows the two parts that have been joined together.

[0023] Figure 11 It is a cross-sectional view taken along line 11-11 in Figure 10.

[0024] Figure 12 It is a cross-sectional view taken along line 12-12 in Figure 10.

[0025] Figure 13 yes Figure 7 A cross-sectional view of the end of the component shows the needle guide used to guide the needle.

[0026] Figure 14 They are needle guides with different styles. Figure 7 A partial cross-sectional view of the component.

[0027] Figure 15 yes Figure 14 The view of the components shows the needle guide in use.

[0028] Figure 16 This is an isometric view of a duodenoscope assembly, which includes an ultrasound imaging subassembly.

[0029] Figure 17 It is in a dismantling state. Figure 16 Axonometric view of the components.

[0030] Figure 18 yes Figure 16A cross-sectional view of the component, with dashed lines indicating different locations used for a part of the component.

[0031] Figure 19 This is an isometric view of an alternative embodiment of the duodenoscope assembly.

[0032] Figure 20 It is in a dismantling state. Figure 19 Axonometric view of the components. Detailed Implementation

[0033] definition

[0034] As used in this application, the term "endoscope" refers to an illuminated, optical, typically elongated and tubular instrument used to visualize deep within the body and for use in procedures referred to as "endoscopic examination." The term includes, but is not limited to, upper endoscopes, duodenoscopes, colonoscopes, and bronchoscopes, as well as devices simply referred to as "endoscopes."

[0035] describe

[0036] In a first preferred embodiment, the imaging assembly 10 includes an upper endoscope 12 and an ultrasound assembly 14, the ultrasound assembly 14 being attached to the endoscope 12 by a retaining element 18 integral with the ultrasound assembly 14. The assembly 14 also includes an ultrasound imaging (also referred to as a “transducer”) head 20, which is electrically connected to a multi-signal path cable 22 via a flexible circuit 50 (also in the form of a signal path cable), the flexible circuit 50 including a set of parallel electrical leads, which may be traces. The cable 22, having multiple signal paths extending through it, terminates at a connector 24 adapted for connection to an imaging station. An element 16 may be a rubber band, or some other form of elastic band or clip, to help retain the cable 22 on the side of the endoscope 12. A tension member 30, such as a thread (which may also have a certain compressive strength), is attached to a protrusion 32 on the ultrasound imaging head 20 and extends through a lumen 34 ( Figure 2 The port 36 appears outside the proximal end of the endoscope 12 for manipulation. In an embodiment, the tension member 30 does not extend through the lumen 34, but extends along the side of the endoscope 12 and is held by element 16 in an embodiment, which is located from... Figure 1 The simplified shape shown includes an eyelet to create a guide path for the tension member 30. In one embodiment, the tension member 30 is attached to controls on the proximal end of the endoscope 12 for ease of manipulation. In this embodiment, these controls may be in the form of spools that can be easily deployed or retracted. The endoscope 12 is also equipped with inherent controls for deflecting the tip of the insertion tube to facilitate introduction to the site of interest.

[0037] In an alternative embodiment, tension member 30 is replaced by a tension member extending along the exterior of the endoscope to a fixation point on the endoscope tip. The physician can apply traction to tension member 30 in any of a variety of ways to cause the ultrasound imaging head 20 to bend rearward toward retaining member 18, which is a flexible, elastic neck 38. Figure 2 As permitted by law. In one method, a rotatable element is used to pull back the tension member 30.

[0038] In a preferred embodiment, the endoscope 12 includes, at its distal end, elements for guiding the alignment of the retaining element 18. For example, the endoscope 12 may include, at its distal end, a groove into which a key element on the retaining element 18 engages. In another embodiment, the orientation guide includes a pin mating in the lumen 34, which is used to guide the correct orientation of the retaining element 18. In one embodiment, component 14 is configured to be disposed of after single use and used in this manner. In another embodiment, component 14 is configured to be properly prepared and / or cleaned after use for reuse. Although until recently, disinfection procedures were generally considered sufficient, detected instances of endoscopic infection transmission have led to the use of advanced disinfection techniques for endoscopes. These disinfection techniques utilize chemicals to kill any pathogens remaining on the endoscope after use. Other disinfection or sterilization techniques may be used, including treatment with ultraviolet light and / or gases such as ozone. In the context of this application, the term "cleaning" encompasses all disinfection and sterilization techniques. Typically, the materials used in endoscopes make autoclaving of the endoscope or its accessories impractical.

[0039] refer to Figure 3 and Figure 4 A flexible circuit 50, passing through a flexible neck 38, electrically connects the imaging head 20 to the cable 22. The flexible circuit 50 has electrical leads for each transducer element in the ultrasonic element array 52 residing in the ultrasonic imaging head 20 to drive and relay signals from the ultrasonic element array 52. ​​The array 52 is covered with a protective coating 53. In an alternative preferred embodiment, the flexible circuit 50 extends from the imaging head 20 to (or through) a connector 24, which may define multiple coaxial cables and have direct contact with the elements of the ultrasonic array 52. ​​In another alternative embodiment, the cable 22 comprises a set of coaxial cables bonded to an adhesive and protective material such as a polymer and extends from the connector 24 to the imaging head 20. In yet another embodiment, an optical fiber is used instead of the cable 22, with a photoelectric transducer located at its distal end. In any of these arrangements, elements 22 and 50 may be referred to individually or in combination as multi-signal path cables.

[0040] In a preferred embodiment, the biopsy needle 60 ( Figure 5 andFigure 6 A long, flexible, hollow filament is formed at its pointed distal end. This filament is sheathed in a flexible catheter (not shown) that is thin enough to extend through lumen 34 and protect endoscope 12 from damage by needle 60. Once the catheter reaches the distal end of endoscope 12, it can be pushed out to extend from lumen 34 and provide further guidance for needle 60, which is withdrawn from the catheter at a point distal to the tip of endoscope 12. Alternatively, the catheter can be pushed approximately to the tip of lumen 34, at which point the needle is withdrawn from the catheter. Reference Figure 5 In an alternative preferred embodiment, the tension member 30 extends through the channel 33 in the retaining element 18 to reach the protrusion 32. The figure also shows that the needle 60 has been pushed through the lumen of the endoscope 12 and extends from the distal end of the lumen. An orifice 40 is defined in the neck 38, corresponding to an orifice in the flexible circuit 50, which is aligned with the orifice 40. Figure 6 It shows something similar to Figure 5 In one embodiment, however, the tension member 30 extends through a pair of holes 35 supported on the retaining element 18. A slightly different embodiment is also shown. Figure 6 The retracted imaging head 20 and the needle 60 extending through the aperture 40 are also shown, as if for a biopsy. Clearly, in this position, the needle will be within the field of view of the ultrasound array 52. ​​In an embodiment, the tension member 30 can pull the head 20 at an obtuse angle relative to the distal end of the endoscope 12. Typically, the aperture 40 is elongated elliptical in shape so that the needle 60 can pass through the aperture at a wide range of bending angles in the neck 38. In another preferred embodiment, a flexible catheter extends distally from the lumen 34 into a V-shaped notch (not shown) on the surface of the flexible neck 38, thereby aligning the catheter so that the needle 60 is aligned to pass through the aperture 40.

[0041] To use the imaging assembly 10, the ultrasound assembly 14 is attached to the endoscope 12 via a retaining element 18. In an alternative embodiment, a rubber band or clip 16 holds the cable 22 to the side of the endoscope 12. The imaging head 20 is then delivered to the area of ​​interest using standard endoscopic introduction techniques. The imaging head 20 can then be moved using dedicated controls that deflect the ultrasound imaging head 20 to obtain an image of the area of ​​interest. If a finding to be sampled is present, a needle 60 can be introduced through the lumen of the endoscope and through the orifice 40 for biopsy, drug injection, or other medical procedures. Finally, the needle 60 is retracted through the lumen of the endoscope 12, and the endoscope is removed from the patient. In other embodiments, the needle 60 is omitted, and an assembly similar to the imaging assembly 10 but without the needle 60 and associated elements is used for imaging alone.

[0042] Figures 7 to 13An alternative embodiment 70 of component 10 is shown, with a further innovation in a disposable head movement sub-assembly 72, which includes a head clip 74, a movement cable 76, a cable clip 78, and a conduit 80 that holds the main portion of the movement cable 76. The clip holder 84 is defined on the rear of the imaging head 20'. Figures 9 to 10 are shown in Figure 9. Figure 12 Figure 9 shows the engagement of the head clip 74 with the clip holder 84. Figure 10 shows the head clip 74 at the distal end of the clip holder 84 and being pulled back onto the clip holder 84. Figure 11 and Figure 12 Different cross-sectional views of the head clip 74 and clip retainer 84 joined together are shown.

[0043] Another difference between component 70 and component 10 is the presence of pin guide 90. Figure 7 Two additional variations of the needle guides 90' and 90' are shown. In assembly 10, a needle 60 extended from the lumen of endoscope 12 may miss the orifice 40 in the neck 38 and be blocked by the neck 38, preventing further advancement. This can occur if the user attempts to push the needle 60 into use when the neck 38 is not sufficiently retracted to allow the orifice 40 to enter the correct position for the needle 60 to pass through. The result could be damage to the imaging head 20' caused by the needle 60. The needle guide 90 engages with the orifice 40 such that when the head 20' is not properly positioned to align the orifice 40 with the path of the needle 60, the needle 60 will be definitively guided to the orifice 40 or blocked by the needle guide 90. Figure 13 The diagram shows the needle guide 90 in use when the head 20' is fully pulled back to the forward-looking position as the needle 60 advances through the orifice 40 with the assistance of the needle guide 90. This is another advantage of assembly 70 (and assembly 10), namely that the head 20' can be moved to... Figure 13 The forward viewing position shown is helpful to surgeons for certain types of procedures. (Reference) Figure 14 and Figure 15 In variant 70' of component 70, a needle guide 92 is provided in the form of a thread along which the needle 60 advances. When not in use, the needle guide 92 is held in a slot 94 of the needle guide. Figure 15 )Inside.

[0044] Now for reference Figures 16 to 18 The duodenoscope assembly 110 includes a duodenoscope 111, which has a disposable needle guide head 112 (in... Figure 18(Most clearly shown), it has a needle guide 114 extending outward at an angle between a first lateral direction L and a distal direction P. In response to changes in user input via a tension member and a variable guide member (not shown), the guide head 112 can change the orientation of the needle guide 114. Reference Figure 16 The cable / head subassembly 120 includes an ultrasound imaging head 122, an endoscope clip 124, and a multi-signal path cable 126. The multi-signal path cable 126 transmits signals to and relays signals from the imaging head 122. The signal paths of the cable 126 can be electrical conductors, and more specifically, each can be a trace on a coaxial cable or a flexible circuit. Other forms of signal paths are also possible. The imaging head 122 is shown having a signal emitting surface facing a first lateral direction L, and a clip holder 128 ( Figure 17 Located on the head 122 and on a side removed from the signal emitting surface in a second lateral direction, opposite to the first lateral direction L. The imaging head moving subassembly 140 includes: a head clip 142 shaped to engage with a clip holder 128; a moving cable 144; a cable clip 146; and a conduit 148 that holds the main portion of the moving cable 144. Reference Figure 11 When cable 144 is pulled, it pulls the imaging head 122 backward, as shown by the dashed line. In some embodiments, subassembly 140 further includes an actuator (not shown) at its proximal end to allow the operator to pull back cable 144, thereby pulling the imaging head 122 or releasing cable 144, or to push the imaging head 122 or allow the elasticity of the material of cable 126 to position the head 122 at its distal end more aligned with the longitudinal dimension of the duodenoscope 111. The actuator of cable 144 may take the form of a wheel, lever, or any other arrangement structure convenient to the user.

[0045] Because disinfection techniques typically require the application of chemicals in liquid form, it is generally undesirable to have narrow slits where the liquid may not easily flow. Therefore, the clip holder 128 is designed not to define any narrow slits along with the imaging head 122. In an alternative preferred embodiment, the clip holder 128 may have a knob-like shape to further avoid defining any narrow slits.

[0046] As described in the background section, sterilization of devices such as component 110 is a significant concern because there have been instances of multi-antibiotic resistant bacterial strains being transmitted through the reuse of duodenoscopy. One area that can prove particularly difficult to sterilize is catheter 148, as the moving cable 144 tends to introduce bodily fluids into catheter 148 when the imaging head 122 is pulled back into it. To address this issue, the head moving sub-assembly is designed to be released and removed from the rest of component 110 and is manufactured inexpensively for single-use and subsequent disposal. This eliminates the possibility of infection spreading between patients via sub-assembly 140. Cable / head sub-assembly 120 does not have a similar structure that would provide access to hard-to-reach locations, making sterilization difficult and tending to be more expensive due to the need to include numerous filaments or other forms of signal paths. Therefore, cable / head sub-assembly 120 is designed to be cleaned and reused.

[0047] Before performing endoscopic (duodenoscopy) surgery, the surgeon obtains the unused head movement sub-assembly 140 and attaches it to the rest of the assembly 110. After use, the user disassembles and disposes of the sub-assembly 140.

[0048] refer to Figure 16 The movable cable 144 can be pulled back to allow the head 122 to face a more distant direction. In one embodiment, due to the elasticity of the neck 150, and in another embodiment, due to the stiffness and compressive strength of the cable 144, pushing the cable 144 forward allows the head 122 to adopt the lateral view shown.

[0049] refer to Figure 19 and Figure 20 In an alternative preferred embodiment of the duodenoscope assembly 210, a retainer 224 surrounds the duodenoscope 211, the cable / head subassembly 220, and the imaging head movement subassembly 240. A clip 225 also helps to hold these components together.

[0050] Industrial applicability

[0051] This invention has industrial applicability in the field of manufacturing auxiliary devices for endoscopes.

[0052] While many exemplary aspects and embodiments have been discussed above, those skilled in the art will recognize certain modifications, substitutions, additions, and sub-combinations therein. Therefore, it is intended that the appended claims and the claims introduced below be construed as including all such modifications, substitutions, additions, and sub-combinations within their true spirit and scope.

Claims

1. An endoscope attachment assembly with ultrasound capability, comprising: An ultrasound assembly, the ultrasound assembly comprising: Multi-signal path connector; An ultrasonic transducer head, comprising an ultrasonic transducer; and A set of signal paths extending from the ultrasonic transducer head to the multi-signal path connector; and An attachable imaging head movement subassembly is configured to be selectively attached to an endoscope via a cable clip, wherein the imaging head movement subassembly is further configured to be selectively attached to an ultrasound assembly via a clip holder, the imaging head movement subassembly is further configured to move the ultrasound transducer independently of the endoscope when selectively attached to the ultrasound assembly and the endoscope, and the imaging head movement subassembly can be disposed of when selectively detached from the ultrasound assembly and the endoscope after use.

2. The endoscope attachment assembly with ultrasound capability according to claim 1, wherein, The ultrasound assembly also includes a flexible neck to which the ultrasound transducer head is physically attached, and the imaging head movement subassembly includes a tension member extending from the ultrasound transducer head to a proximal end located at the proximal end of the endoscope, and applying a force to the tension member causes the ultrasound transducer head to change position.

3. The endoscope attachment assembly with ultrasound capability according to claim 1, wherein, The signal path is an electrical conductor.

4. The endoscope attachment assembly with ultrasound capability according to claim 3, wherein, The electrical conductor is a coaxial cable.

5. The endoscope attachment assembly with ultrasound capability according to claim 3, wherein, The electrical conductor is a flexible circuit trace.

6. The endoscope attachment assembly with ultrasound capability according to claim 1, wherein, The ultrasound assembly also includes an attachment element, and the ultrasound assembly is attached to the endoscope at least in part by attaching the attachment element to the distal end of the endoscope.

7. The endoscope attachment assembly with ultrasound capability according to claim 6, wherein, The attachment element is a clip, the size and shape of which are configured to engage the distal end of the endoscope.

8. The endoscope attachment assembly with ultrasound capability according to claim 1, wherein, The endoscope also receives a needle and a mechanism for extending the needle out of the endoscope to perform a biopsy.

9. The endoscope attachment assembly with ultrasound capability according to claim 8, wherein, The ultrasound assembly also includes a flexible neck to which the ultrasound transducer head is physically attached, and the neck further defines an orifice that can be aligned to allow the needle to pass through the neck.

10. The endoscope attachment assembly with ultrasonic capability according to claim 9, wherein, The orifice is an elongated ellipse, and the needle can pass through the orifice when the neck is bent at any angle selected from a wide range of bending angles.

11. The endoscope attachment assembly with ultrasonic capability according to claim 9, wherein, When the neck is bent by the tension member and the needle passes through the orifice, the needle is visible in the field of view of the ultrasonic transducer, allowing the user to guide the needle more accurately.

12. The endoscope attachment assembly with ultrasonic capability according to claim 1, wherein, The ultrasonic transducer is a capacitive micromechanical ultrasonic transducer.

13. The endoscope attachment assembly with ultrasonic capability according to claim 1, wherein, The endoscope is configured to be cleaned and reused after use when the imaging head moving sub-assembly is selectively removed from the endoscope.

14. The endoscope attachment assembly with ultrasound capability according to claim 1, wherein, The ultrasound assembly is configured to be cleaned and reused after use when the imaging head moving sub-assembly is selectively removed from the ultrasound assembly.

15. The endoscope attachment assembly with ultrasonic capability according to claim 14, wherein, The ultrasound-enabled endoscope attachment assembly also includes a sealable package configured to contain the cleaned ultrasound assembly before reuse.

16. The endoscope attachment assembly with ultrasound capability according to claim 1, wherein, The endoscope in question is a duodenoscope.

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