Advancing Military Medicine With AI-Enhanced Ultrasound

By Paul Sheeran, Ph.D. — Director of Research & Development at RIVANNA

For over a decade, RIVANNA has been at the forefront of imaging innovation, developing AI-driven procedural guidance to improve clinical outcomes. Now, with the support of a $3M Technology/Therapeutic Development Award (TTDA) grant from Congressionally Directed Medical Research Programs (CDMRP), RIVANNA is applying this expertise to a critical gap in military medicine — spinal interventions for forward-deployed service members.

Each year, nearly 150,000 U.S. military personnel experience back pain and spinal injuries, leading to an estimated 6 million limited-duty days and a cost around $2B annually. While epidural steroid injections (ESIs) are a proven treatment, access is severely limited due to reliance on fluoroscopic imaging, which is impractical in forward-deployed settings.

To address this gap in military healthcare, RIVANNA is developing Accuro 3S-MIL: a portable, AI-powered ultrasound guidance system designed specifically for military use cases. This technology will provide an effective alternative when fluoroscopy isn’t feasible, streamline workflow for non-specialist providers, and will ultimately reduce evacuations while improving return-to-duty rates. This marks a tremendous milestone for RIVANNA as we expand our impact beyond civilian healthcare and into military medicine, bringing world-first innovation to injured service members in austere environments.

The Challenge: Limited Imaging Solutions for Military Pain Management

Spinal injuries occur frequently in active-duty populations. Whether from high-impact physical demands, repetitive strain, or combat-related trauma, service members face musculoskeletal risks that demand prompt intervention. Yet, the military healthcare system encounters serious barriers to delivering these interventions effectively in operational settings:

ESIs require fluoroscopic imaging for accuracy, yet fluoroscopy systems are too large, costly, and infrastructure-dependent for most field settings.
Frontline medical personnel often lack the advanced imaging and procedure guidance skills required to perform interventions like ESIs safely and effectively.
The gap in advanced imaging and training contributes to treatment delays, prolonged suffering, and frequent evacuations to facilities with advanced capabilities that are further from the operational position.
Preventable evacuations strain the military healthcare system, reduce return-to-duty (RTD) rates, and limit operational effectiveness.

While ESIs are widely accepted as a best-practice treatment for chronic and acute back pain, they require image guidance to ensure accuracy and safety. In civilian hospitals, fluoroscopy is the standard. However, in military field operations, the required infrastructure is lacking for fluoroscopy. This greatly limits access to effective treatment for service members.

Delayed interventions can result in extended evacuations, longer recovery times, and increased likelihood of chronic pain. The operational consequences are equally serious: decreased readiness, increased logistical strain, and long-term loss of skilled personnel.

There is no question about the need. The question has always been how to meet it.

RIVANNA’s Legacy of Spinal Ultrasound Innovation

RIVANNA’s AI-powered ultrasound guidance technology is uniquely positioned to resolve limitations to care for chronic and acute back pain in military medicine. Our flagship Accuro Neuraxial Guidance platform, alongside the upcoming Accuro 3S, was built to simplify spinal imaging and procedural guidance. By integrating artificial intelligence into a point-of-care ultrasound device, Accuro enables providers to visualize spinal landmarks, automate anatomical interpretation, and navigate with precision and confidence.

This philosophy of simplifying complexity is core to our work. In civilian contexts, Accuro has demonstrated that it can improve first-attempt success rates, reduce complications, and expand access to neuraxial anesthesia and pain interventions. It bypasses guesswork by identifying midline, depth, and insertion trajectory in real time. What once required specialized training and equipment can now be executed confidently at the bedside.

Our upcoming Accuro 3S platform has been developed to address some of the barriers that still existed with Accuro. Namely, the need for real-time needle tracking and workflow solutions that allow a single provider to image continuously while performing manual interventions throughout procedures.

Accuro 3S-MIL will build on these core capabilities and take them further:

Fully ruggedized for harsh field environments
Compact and lightweight for portability
Integrated with military EHRs, including the Battlefield Assisted Trauma Distributed Observation Kit (BATDOK)
Imaging and AI algorithms tailored for optimal performance on the anatomical and demographic diversity of military personnel

For military applications, the forthcoming Accuro 3S-MIL is not a general-purpose ultrasound unit retrofitted for this use case. It is a purpose-built system, designed from the ground up to meet the needs of military clinicians and their patients.

Securing the CDMRP Grant

Receiving the TTDA award from the CDMRP is a defining milestone that reflects both the quality of our technology and the clarity of its mission-driven impact. CDMRP grants are reserved for technologies that promise high-value, near-term improvements to military medicine. They are awarded only after extensive review, scored by domain experts, and evaluated across technical merit, feasibility, and military relevance.

RIVANNA’s proposal was distinguished by more than technical excellence. It was strengthened by a collaborative network of military and civilian pain management thought leaders who share our vision:

DoD Co-Principal Investigator: Xiaoning (Jenny) Yuan, Assistant Professor and Vice Chair for Research in Physical Medicine & Rehabilitation at the Uniformed Services University of the Health Sciences (USU); Director of the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) Program; active clinician at Walter Reed National Military Medical Center (WRNMMC).
DoD Co-Investigator: Edward Dolomisiewicz, Associate Program Director of the Physical Medicine and Rehabilitation Residency Program at WRNMMC in Bethesda, MD.
Subject Matter Expert: Steven P. Cohen, Edmond I Eger Professor of Anesthesiology, Vice Chair of Research at Northwestern University; Professor and Director of Pain Research, Walter Reed National Military Medical Center; President-elect of the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine); retired U.S. Army Colonel; recognized as a leading expert in pain management.
Subject Matter Expert: Amitabh Gulati, President of the World Academy of Pain Medicine United (WAPMU); Director of Chronic Pain at Memorial Sloan Kettering Cancer Center in New York City.

Together, we’re developing a solution that is not only technologically sound but also operationally relevant and grounded in clinical reality. Our collaboration with The Geneva Foundation, a leading non-profit organization that facilitates the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) program, plays a pivotal role in this effort, as does institutional support from Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences. These partners bring deep operational insight into the needs of the Military Health System, helping ensure our solutions are not only technically advanced but also aligned with broader goals like improved clinical decision support, enhanced readiness, and seamless data interoperability.

Working together, we’re accelerating the modernization of military healthcare delivery and strengthening the future of care for service members and their families.

Developing Accuro 3S-MIL

Over the next 36 months, this CDMRP funding will support the full development cycle of Accuro 3S-MIL. The work will be comprehensive, iterative, and centered on real-world usability.

Phase 1: We will begin with rigorous end-user research, including extensive usability studies. Our team will work directly with military clinicians to understand their operational context, workflow requirements, and user constraints. This research will inform every element of our engineering effort.
Phase 2: We will translate those insights into a ruggedized, AI-powered ultrasound system tailored for the battlefield. This includes advanced algorithms to automate landmark recognition and guide epidural steroid injection procedures, dual-array probes for facile needle insertion guidance. Our AI will be tuned specifically to military demographics, improving accuracy across varied body types and field conditions.
Phase 3: We will integrate the system with military infrastructure. This includes electronic health record (EHR) compatibility with systems like BATDOK and adherence to cybersecurity protocols essential for defense health operations. We will also transition from prototype to deployable hardware, optimizing for a low SWaP profile (size, weight, and power).
Phase 4: We will execute validation studies in a military hospital setting to ensure the system meets performance benchmarks and can be operated effectively by non-specialist users.

This development cycle is not just a rigorous process for building a powerful, beneficial, and fully effective device. It’s an intentional framework for earning military buy-in, validating capability, and ensuring continuity of care — even in especially challenging contexts. Following development and validation, RIVANNA intends to seek FDA clearance to enable broader clinical deployment of Accuro 3S-MIL.

Expanding the Impact to Civilian Medicine

While Accuro 3S-MIL is designed with military healthcare in mind, the innovations involved extend broadly to meet healthcare needs beyond military medicine. Once validated and cleared, this technology will have clear applicability in civilian medicine — particularly in underserved or infrastructure-limited environments.

Rural and under-resourced communities: In regions where access to fluoroscopy is limited, inaccessible, or under-resourced, Accuro 3S-MIL can enable local providers to deliver pain interventions without relying on large imaging suites or subspecialist availability.
Emergency settings: Accuro 3S-MIL’s portability becomes its defining strength. EMS teams responding to trauma outside of hospital settings can use the system to perform immediate assessments or administer image-guided interventions for pain management on-scene or en route.
Sports and wilderness medicine: Athletes and outdoor professionals suffer spinal injuries in environments where advanced imaging is unavailable. Accuro 3S-MIL could provide real-time procedural guidance for orthopedic and pain interventions, even in remote conditions.

The development of 3S-MIL will directly inform subsequent innovations across RIVANNA’s product portfolio, including new hardware configurations and AI capabilities. The form factor, workflow, and AI-enhanced guidance developed for Accuro 3S-MIL could become the blueprint for a new class of procedural imaging tools — tools that prioritize ease of use, portability, and accessibility without compromising clinical rigor.

We believe the technologies developed under this award will not only improve outcomes for service members, but also drive forward the next wave of precision medicine across civilian healthcare settings.

Advancing Military Medicine — One Innovation at a Time

Earning this CDMRP TTDA award is an opportunity for RIVANNA to drive meaningful change. Over the next 36 months, we’ll continue to work in close collaboration with military healthcare leaders, research institutions, and clinical experts to bring Accuro 3S-MIL to life.

By integrating AI-driven ultrasound with military EHR systems, designing a ruggedized, portable platform, and ensuring usability for non-specialist providers, we’re setting a new standard for point-of-care spinal interventions. And this impact won’t stop with the military — our research will inform future applications in emergency medicine, rural healthcare, and civilian pain management.

At RIVANNA, we believe that technology should remove barriers. Accuro 3S-MIL embodies this philosophy — delivering precision, accessibility, and innovation where they’re needed most. This is just the beginning.

Follow our journey as we work to transform pain management in military and civilian healthcare.

Acknowledgement

The U.S. Army Medical Research Acquisition Activity, 808 Schreider Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. This work was supported by The Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, in the amount of $3 million through the Peer Reviewed Medical Research Program under Award Number HT94252510463. Opinions, interpretations, conclusions, and recommendations are those of the author(s) and are not necessarily endorsed by The Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense.