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3.  To obtain objective data  To visualize invisible changes and conditions  To learn more - faster  To help improve treatment and life quality for patients  To improve quality of products  To lower cost of product development 3 CORTEX TECHNOLOGY DENMARK

4.  Prior to therapy (e.g. tumors, port wine stains)  Follow-up (e.g. wound healing, tumors, port wine stains, aging)  To document product claims (cosmetics, pharma.)  To obtain accurate and reproducible data for basic research 4 CORTEX TECHNOLOGY DENMARK

5.  In dermatology & plastic surgery (clinically, research)  Pharmaceutical industry  Cosmetic and aesthetic industry  Others - neuro medicine, wound healing, paediatrics, occupational medicine etc. 5 CORTEX TECHNOLOGY DENMARK

6.  Scientific skin research  Irritancy/allergy testing  Wound healing  Collagen (photo damage, skin aging, skin rejuvenation)  Cellulite (efficiency of treatment)  Scleroderma, Psoriasis  Tumors (basal cell, squamous cell, malignant melanoma …)  Vascular lesions (port wine stains, hemangioma)  Claims substantiation (cosmetics and pharma.) 6 CORTEX TECHNOLOGY DENMARK

7.  Frequency  20.000 Hz (20 kHz) Ultrasound Echograpy Sonography 7 CORTEX TECHNOLOGY DENMARK

8.  Conventional ultrasound: f max < 10 MHz + High penetration + Wide application range + Wide price range 8 CORTEX TECHNOLOGY DENMARK - Low resolution

9.  High resolution ultrasound: f = 20 MHz or higher + High resolution + High definition 9 CORTEX TECHNOLOGY DENMARK - Low penetration - Limited to skin / subcutis

10. skin boundaries 10 CORTEX TECHNOLOGY DENMARK

11. Skin CORTEX TECHNOLOGY DENMARK 11 Transmitted pulse of ultrasound Received signal (A-scan)

12. 12 CORTEX TECHNOLOGY DENMARK Probe One image consists of 224 lines of ultrasound A-scan

13. Normal face scan, young lady, near eye 13 CORTEX TECHNOLOGY DENMARK Epidermis Dermis Subcutis Probe Water Film Gel

14. In-depth penetration Sound beam Focal zone Active element (x-tal) Transducer housing Skin surface Water/gel path 14 CORTEX TECHNOLOGY DENMARK Skin

15.  Axial resolution (R ax ) is determined by the sound velocity (v) and the system bandwidth (BW) where BW ~ 75% of F crystal E.g. 20MHz: v ~ 1580 m/s, BW ~ 0,75 * 20 MHz => R ax ~ 60 µm 50MHz: v ~ 1580 m/s, BW ~ 0,75 * 50 MHz => R ax ~20 µm  Lateral resolution is determined by the beam diameter (diameter determined by acoustic focusing) typically 150 µm 15 CORTEX TECHNOLOGY DENMARK Higher ultrasound frequency  higher band-width  higher resolution

16.  Determined by focal distance (water/gel path)  Determined by attenuation (1 dB / MHz / cm) 16 CORTEX TECHNOLOGY DENMARK Higher ultrasound frequency  lower penetration into the skin Selection of ultrasound frequency is a trade-off between resolution and penetration

17. Nail foil – 20 MHz and 50 MHz Notice the higher resolution but lower penetration in the 50 MHz image 17 CORTEX TECHNOLOGY DENMARK

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19. 19 CORTEX TECHNOLOGY DENMARK Probe Normal skin Malignant Melanoma Thin and photo-aged (Steroid atrophy) Scar tissue

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23. Normal photo-aged skin Notice : The Collagen structure changes over time (colors disappear over time) 20 years 30 years 40 years 50 years 23 CORTEX TECHNOLOGY DENMARK

24. 24 CORTEX TECHNOLOGY DENMARK Cellulite After AHA peeling

25. Hemangioma in the face 25 CORTEX TECHNOLOGY DENMARK

26. Scar tissue 26 CORTEX TECHNOLOGY DENMARK

27. BCC, various body sites 27 CORTEX TECHNOLOGY DENMARK

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29.  Distance (A-scan, arbitrary, B-scan edge/peak detect.)  Intensity (B-scan edge/peak detection, Region of Interest)  Area (B-scan edge/peak detection, Region of Interest)  Volume (3D-scan only) 29 CORTEX TECHNOLOGY DENMARK

30. Insect bite 30 CORTEX TECHNOLOGY DENMARK

31. Insect bite 31 CORTEX TECHNOLOGY DENMARK

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