the following description is of the best mode presently contemplated for carrying out at least one embodiment of the invention . this description is not to be taken in a limiting sense , but is made merely for the purpose of describing the general principles of the invention . the scope of the invention should be determined with reference to the claims . fig1 shows an active implantable medical therapy and / or monitoring system as an implant 100 , according to one or more embodiments of the invention . fig1 shows the block diagram of the implant 100 , according to at least one embodiment of the invention . as shown in fig1 , in one or more embodiments , the implant 100 includes one or more ultrasonic transducers 110 , mounted on the housing of the implant 100 or as a component of an electrode line connected to the implant 100 . in at least one embodiment , the ultrasonic transducer 110 is connected to an ultrasound transmitting and receiving unit 120 , which is in turn connected to a control and evaluation unit 130 . in one or more embodiments , the control and evaluation unit 130 may start an ultrasound scan , either cyclically or triggered by certain events , and may evaluate the received ultrasonic signals in order to assess the current position of the implant or of the electrode line . in at least one embodiment , the assessment may be performed based on one or more of ultrasound propagation times , frequency shifts ( doppler effect ), amplitude values and phase positions . one or more embodiments may include a telemetry unit 140 with antenna 150 , such as part of the implant 100 , wherein the telemetry unit may be connected to the control and evaluation unit 130 , such that an identified dislocation may be signaled accordingly . in at least one embodiment , the implant may include one or more units used to provide therapy or monitoring . in one or more embodiments , the ultrasonic frequencies to be used may lie in the region of ˜ 1 mhz , such that a penetration depth of approximately 50 cm is provided . in at least one embodiment , the ultrasonic frequencies used may depend on application - specific differences . fig2 illustrates a first application example of a dislocation sensor , according to one or more embodiments of the invention . at least one embodiment may include an implantable cardiac pacemaker 210 connected to an implantable electrode line 220 , wherein the implantable electrode line 220 may include an ultrasonic transducer 230 . in one or more embodiments , a stimulation electrode pole that includes a ring electrode 240 and a tip electrode 270 may be located in the distal region of the electrode . in at least one embodiment , the ultrasonic transducer 230 , together with the associated ultrasound transmitting or receiving unit and the control and evaluation unit , may establish the blood flow in the vena cava using a heart frequency - synchronous measurement and frequency evaluation ( doppler effect ), such that the position of the electrode is confirmed . in one or more embodiments , the heart frequency - synchronous measurement may be applied to identify the dislocation of pulmonary artery pressure sensors . fig3 shows a further implementation example for a propagation time measurement , according to one or more embodiments of the invention . in at least one embodiment , the implant 210 may be connected to an electrode line 220 that includes a mini piezo ultrasound transmitter 230 and a stimulation electrode pole 240 . in one or more embodiments , the ultrasound transmitter 230 may be mounted in the vicinity of the stimulation electrode pole 240 . in at least one embodiment , an ultrasound receiver 250 may be mounted on the implant housing 210 . by way of one or more embodiments , in order to assess the position of the stimulation electrode pole 240 , the ultrasound propagation time between transmitter 240 and receiver 250 may be evaluated . in at least one embodiment , if the ultrasound propagation time between transmitter 240 and receiver 250 changes beyond an admissible measure , a dislocation of the electrode tip is indicated . in order to improve the specificity and sensitivity , in one or more embodiments , the propagation time measurement may be performed continuously over a heart cycle . in at least one embodiment , a differentiation of a micro - dislocation with additional secondary electrode movements , such as unphysiological “ wobbling ” of the electrode tip , may be performed based on a movement curve obtained therefrom . in one or more embodiments , the implant 210 may include a detection unit 260 that records an intracardial electrocardiogram , which evaluates an electrophysiological signal recorded via the electrode pole 240 or 270 . in at least one embodiment , the receiver 250 , for example , may correspond to the ultrasonic transducer 110 and the ultrasound transmitting and receiving unit 120 from fig1 . in one or more embodiments , the control and evaluation unit 130 may be connected to the detection unit 260 . in at least one embodiment , the transmitting ultrasonic transducer and the receiving ultrasonic transducer may be swapped , wherein the transmitter is the ultrasonic transducer 250 and the receiver is the ultrasonic transducer 230 . fig4 illustrates a further embodiment of the dislocation identification for ultrasound stereo hearing , according to one or more embodiments of the invention . in at least one embodiment , as shown in fig4 , at least two piezo ultrasonic transducers 420 and 430 together with associated ultrasound transmitting or receiving unit may be mounted on the housing of an implant 410 . in one or more embodiments , the first ultrasonic transducer 420 may be used to emit an ultrasonic pulse , wherein the reflections of the ultrasonic pulse may be received by the first ultrasonic transducer 420 and the second ultrasonic transducer 430 . in at least one embodiment , a 2 - dimensional classification of the ultrasound reflection may be made based on a comparison of the two receivers . for example , in one or more embodiments , the echo of a reflection surface on an electrode may be measured . one or more embodiments may include further receivers , for example for 3 - dimensional classification . in at least one embodiment , the ultrasonic transducers may be provided in the electrode line , and the housing 410 may serve as a reflector for the ultrasound . in one or more embodiments , the ultrasonic transducers may be positioned sufficiently far from one another . by way of at least one embodiment , a very large characteristic echo from the implant housing 410 may be recorded . according to one or more embodiments , the position of a number of electrode portions may be checked at the same time . at least one embodiment of the invention may include a separate echo reflector ( not illustrated in the figures ) implanted as a position reference . one or more embodiments of the invention may include a combination of elements of fig4 and elements of fig3 . in at least one embodiment , the electrode line may include at least one mini piezo ultrasound transmitter ( such as element 230 of fig3 ), and at least two piezo ultrasound receivers ( such as elements 420 , 430 of fig4 ) mounted on the implant . as such , in one or more embodiments , an improvement of the specificity and sensitivity of the dislocation identification may be made possible by evaluation of propagation time and amplitude differences as well as with use of the doppler effect as a result of the moving electrode . in at least one embodiment , the ultrasound transmitter 230 and ultrasound receivers 420 and 430 each have an ultrasonic transducer such as the ultrasonic transducer 110 from fig1 as well as an ultrasound transmitting or receiving unit such as the ultrasound transmitting and receiving unit 120 from fig1 . fig5 a and 5b show a dislocation sensor with ultrasonic reference , according to one or more embodiments of the invention . as shown in fig5 a and 5b , in at least one embodiment , the dislocation sensor may include or may be only one single ultrasonic transducer 520 , 520 ′ on the implant 510 , 510 ′. in at least one embodiment , the ultrasonic transducer 520 , 520 ′ may be part of a sensor that includes an ultrasound transmitting and receiving unit 120 and a control and evaluation unit 130 , which records an ultrasound reflection reference with a determined implant position in the patient 500 , shown in fig5 a , and stores the ultrasound reflection reference . in one or more embodiments , for the subsequent implant monitoring , additional ultrasonic measurements may be taken cyclically and may be compared with the recorded ultrasound reflection reference . in at least one embodiment , if the deviations from the ultrasound reflection reference exceed a limit value , a dislocation may assumed and signaled , as shown in fig5 b . in one or more embodiments , the constructions shown in fig5 a and 5b may be used when a twisting of an implant ( for example a heart monitor ) is to be identified . by way of at least one embodiment , active implants with the described ultrasonic dislocation sensor may be insulin pumps , ventricular assist devices ( vads ), implantable monitors , pillcam implants , neurostimulators , stimulators that provide cardial resynchronization , implantable controllers for orthopedic implants , and retina implants . in one or more embodiments , the ultrasonic monitoring of the implant may provide an active monitoring of only passive implants , such as orthopedic prostheses . in at least one embodiment , ultrasonic transducers used in medical ultrasonic diagnosis systems , such as 3d and 4d echocardiography with matrix technology , may be miniaturized to a size of , for example , 350 μm and may be used without limitation for all specified implant applications described herein . it will be apparent to those skilled in the art that numerous modifications and variations of the described examples and embodiments are possible in light of the above teaching . the disclosed examples and embodiments are presented for purposes of illustration only . other alternate embodiments may include some or all of the features disclosed herein . therefore , it is the intent to cover all such modifications and alternate embodiments as may come within the true scope of this invention .
embodiments include an active implantable medical therapy and / or monitoring system that includes at least one implant . the at least one implant includes at least one ultrasonic transducer directly or indirectly connected to a control and evaluation unit in order to emit and receive ultrasonic signals . the control and evaluation unit prompts an emission of ultrasonic signals by the at least one ultrasonic transducer cyclically or in a triggered manner and evaluates received ultrasonic signals such that the control and evaluation unit identifies an actual position or change in position of one or more of the at least one implant and an electrode line .