04 History of Ultrasound: Lecture by Dr. Eric Blackwell on History and Physics
Summary
TLDRThis script recounts the evolution of ultrasound technology from its inception in 1949 for battlefield use to its modern applications in medical imaging. It highlights the transition from rudimentary oscilloscope images to advanced 3D imaging, showcasing remarkable advancements in resolution and portability. The speaker reflects on the pioneers who shaped the field and the current capabilities of ultrasound, including its use in detecting fetal abnormalities and monitoring patient conditions in real-time.
Takeaways
- π°οΈ The first known article on the use of ultrasound in humans was published in 1949 by Dr. George Ludwig, who was exploring its potential to detect foreign bodies in battlefield injuries.
- π Early ultrasound technology was primarily used to measure distances to structures within the body, with images appearing as spikes on an oscilloscope rather than the detailed images we have today.
- π The evolution of ultrasound has been remarkable, from bistable black and white displays to current high-resolution 3D capabilities that allow for detailed examination of soft tissues and bone.
- πΆ Ultrasound technology has advanced to the point where it can capture detailed images of early pregnancies, including the ability to see the yolk sac, amniotic fluid, and placental tissue.
- β€οΈ The resolution of modern ultrasound equipment is so high that it can detect sub-millimeter defects, such as a ventricular septal defect in a fetal heart.
- π The speaker humorously notes the ability to see fetal emotions in 3D ultrasound, showcasing the depth of detail possible with current technology.
- π The speaker acknowledges the contributions of pioneers in the field, such as Dr. Bill McKinney, who was instrumental in advancing the use of ultrasound in medicine.
- π₯ The script mentions the transition from military surplus sonar equipment to medical ultrasound devices, highlighting the repurposed technology's role in early ultrasound development.
- πΊ The evolution from contact B scanners to real-time moving pictures represents a significant technological leap in ultrasound imaging.
- π» The development of portable and handheld ultrasound devices, resembling laptop computers, has made ultrasound more accessible and practical for point-of-care use.
- π The latest advancements include cordless ultrasound transducers, which offer greater flexibility and convenience, especially in sterile environments like surgery.
Q & A
What was the first known application of ultrasound in humans?
-The first known application of ultrasound in humans was in 1949 by Dr. George Ludwig from the Department of Defense, who used it to look for foreign bodies like glass or wood in battlefield injuries that didn't show up on X-rays.
Why was the early ultrasound not effective for detecting foreign bodies in the battlefield?
-The early ultrasound was not effective for detecting foreign bodies because ultrasound waves cannot penetrate certain materials like glass or wood, which are not radio opaque.
How did the ultrasound technology evolve from its first use to the 1970s?
-Ultrasound technology evolved from the initial use in 1949 to the 1970s with the development of images that were displayed on oscilloscopes, which were used to measure distances to structures within the body.
What was the limitation of early ultrasound images in the 1970s?
-The limitation of early ultrasound images in the 1970s was that they were displayed on oscilloscopes with bistable images, either on or off, with no shades of gray, and required a Polaroid camera to capture a permanent picture.
How has the ultrasound technology advanced in terms of image quality and capabilities?
-Ultrasound technology has advanced significantly with the introduction of 3D imaging, color Doppler for blood flow visualization, and high-resolution images that can detect minute details such as sub-millimeter defects in a fetal heart.
What is the significance of the 'point of care' concept in the context of early ultrasound applications?
-The 'point of care' concept refers to the ability to perform medical examinations at the patient's bedside or in the field. The first application of ultrasound was essentially a point of care tool, although it required plugging into an AC power line and was not portable.
What was the role of Dr. Bill McKinney in the development of ultrasound technology?
-Dr. Bill McKinney was a neurologist who became the president of the American Institute of Ultrasound in Medicine. He was instrumental in promoting the use of ultrasound and brought many people into the field, including the speaker of the script.
How did the surplus of sonar equipment from World War II contribute to the development of ultrasound technology?
-The surplus of sonar equipment from World War II provided a foundation for researchers to experiment with ultrasound technology. The equipment was repurposed for medical use, leading to the development of early ultrasound machines.
What was the 'water path' concept in early ultrasound scans?
-The 'water path' concept involved using a plastic bag filled with water to create a medium for the ultrasound waves to travel through. This was necessary because the technology required a water-based environment for the ultrasound waves to be effective.
How did the transition from B-mode scanners to contact B scanners impact the practicality of ultrasound technology?
-The transition from B-mode scanners, which required a water path, to contact B scanners that made direct contact with the skin, made the technology more practical for day-to-day patient care by eliminating the need for a water-filled medium and improving image quality.
What are the benefits of the recent advancements in portable ultrasound devices?
-Recent advancements in portable ultrasound devices, such as the development of handheld units and wireless transducers, have made ultrasound technology more accessible and convenient for various medical applications, including point-of-care diagnostics and surgical assistance.
Outlines
π The Dawn of Ultrasound in Medicine
The script begins by recounting the early history of ultrasound technology, starting from its first known medical application in 1949. Dr. George Ludwig from the Department of Defense was the pioneer, attempting to use ultrasound to detect foreign bodies in battlefield injuries. Although unsuccessful for that purpose, this marked the inception of point-of-care ultrasound. The speaker then reflects on their own experience with ultrasound in 1974, highlighting the evolution from rudimentary spike images on an oscilloscope to modern 3D imaging capabilities. The paragraph also showcases the remarkable advancements in ultrasound imaging, from basic distance measurements to detailed fetal imaging, including the ability to detect minute abnormalities such as a ventricular septal defect.
πΈ Evolution of Sonar and Early Ultrasound Applications
This paragraph delves into the origins of sonar equipment from World War II and its surplus leading to its repurpose in medical settings. The University of Colorado in the 1960s utilized this equipment for scanning, albeit impractically due to the requirement of submersion in water. The script then transitions to the development of contact B scanners, which eliminated the need for a water path and allowed direct skin contact for imaging. Life Magazine's coverage of ultrasound in pregnancy is mentioned, illustrating the shift towards more practical applications. The evolution continues with the advent of real-time moving pictures by the mid-1990s, necessitating dual monitors for grayscale and color imaging. The paragraph concludes with the miniaturization attempts of ultrasound devices, including a battery-powered bedside unit and the emergence of laptop-like machines with high-resolution screens for versatile medical use.
π‘ Innovations in Portable Ultrasound Technology
The final paragraph introduces recent innovations in portable ultrasound devices, emphasizing the convenience and practicality of cordless operation. Siemens' Accuson brand is highlighted for its Bluetooth-enabled transducer, which allows for use in sterile surgical environments without the risk of contamination from cords. The script also mentions the ongoing trend of miniaturization, with many manufacturers now offering handheld units that, while not matching the capabilities of larger machines, provide satisfactory image quality for specific applications. The paragraph underscores the continuous drive for innovation in ultrasound technology, making it increasingly accessible and versatile for various medical scenarios.
Mindmap
Keywords
π‘Ultrasound
π‘Point of Care
π‘Oscilloscope
π‘Resolution
π‘Transducer
π‘Color Doppler
π‘3D Ultrasound
π‘Fetal Imaging
π‘Sonar
π‘Miniaturization
π‘B-Mode
Highlights
In 1949, the first known article about the use of ultrasound in humans was published by the Department of Defense, focusing on detecting foreign bodies in battlefield injuries.
Dr. George Ludwig's initial ultrasound application was to locate non-radio opaque materials like glass or wood in post-accident scenarios.
The early ultrasound technology was not portable and required connection to an AC power line.
In 1974, ultrasound images were rudimentary, with spikes on an oscilloscope used to measure distances to structures.
Ultrasound technology has evolved significantly, from basic distance measurements to detailed 3D imaging with soft and bony tissue information.
Early ultrasound images were bistable, black and white, and required a Polaroid camera for permanent records.
Modern ultrasound scans provide detailed images of early pregnancies, including the embryo and yolk sac, with high-resolution capabilities.
Current ultrasound technology can detect minute details such as a ventricular septal defect in a fetal heart.
Resolution in modern ultrasound is sub-millimeter, allowing for the observation of fetal emotions in 3D scans.
Dr. Bill McKinney, a neurologist and enthusiastic promoter of ultrasound, contributed significantly to the field's growth.
Surplus WWII sonar equipment was repurposed for medical ultrasound research in the 1960s.
Early ultrasound scans during pregnancy involved a water path concept and were displayed on oscilloscope screens.
Contact B scanners eliminated the need for a water path, allowing direct skin contact for ultrasound imaging.
By the mid-1990s, ultrasound units featured real-time moving pictures and color Doppler capabilities.
Miniaturization of ultrasound technology led to handheld devices suitable for specific applications.
Siemens introduced a cordless ultrasound device with a high-frequency radio band for hospital use, enhancing sterility in surgical fields.
Transcripts
1949 i'm an old guy i was only four
years old at the time
the first
article that we know anything about
having to do with the use of ultrasound
in humans came out from the department
of defense from dr george ludwig who
interestingly was using it to look for
foreign bodies
after accidents in the battlefield for
example where you can have things like
glass or wood that are not radio opaque
so they don't show up on x-ray he was
hoping that this might be a way to
actually be able to detect these and it
turns out you can't so this was kind of
an early point of care you know the
point of care thing we kind of is a new
buzzword in ultrasound but so the very
first application was really sort of
point of care the difference was of
course you had to be able to plug this
oscilloscope into an ac power line so it
wasn't exactly portable
but so 1949 that was kind of the
beginning of the concept
now when i started doing ultrasound in
1974
that was an ultrasound we didn't have
images they didn't look like anything
there were these spikes on an
oscilloscope they were purely used to
measure distance to some structure this
is actually measuring from the skull
surface to the midline this is the third
ventricle in here and then that's the
far side of the skull and the hair on
the other side
so
ultrasound has come a long way in the
length of time that i've been fortunate
enough to be involved with it
this was an early ultrasound that's a
early pregnancy where the green arrows
pointing to the fetus
this display is black or white there's
no shades of gray so it's what was
called bistable either on or off and it
was on an oscilloscope if you wanted a
permanent picture you had to take a
picture of the oscilloscope with a
polaroid camera well if you compare that
with what we can do now where we have
the 3d that we can rotate around look in
any direction we have all the soft
tissue and bony information just
remarkable how far it's come in you know
a relatively short period of time so
this is representative of a current high
quality ultrasound scan this is a
transvaginal ultrasound scan of an early
pregnancy and you can see a lot of
things and we'll come back to this same
image a number of times for different
reasons in the course of the talk but so
here's the embryo here this little
bright structure is a yolk sac right out
at the periphery of the amnion the fluid
within the amniotic sac is echo-free the
fluid between the amnion and the corion
has some proteinaceous debris in it so
it has some fine internal echoes and
then when we get out into the placental
tissue and the myomet the muscle of the
uterus of different textures that
actually are helpful to us in deciding
actually what we're looking at and
whether it's normal or abnormal
now in terms of resolution of current
equipment this is a picture of a fetal
heart the four chambers two ventricular
chambers two atria here and this is a
nickel and the heart is about the size
of a nickel at 20 weeks and 20 weeks is
when we usually do the anatomic survey
well not only that but we're able to see
in this case a ventricular septal defect
on color doppler where we're showing
where flow goes flow crosses the septum
and that little defect is about the size
of jefferson's nose so our resolution
now is sub millimeter in most cases and
when we talk about frequency and that
kind of stuff we'll talk about how we
get to this level of resolution and what
you have to do to maximize that on the
equipment wow we can even see fetal
emotions on the 3d this one's obviously
frustrated
you know here's one that's like mr bill
you know who knew
the thinker you know
my favorite one a little
combative action between the twins here
and uh this one who's a little boy who's
just discovered that he's a little boy
well okay so i have to put in my
profound statement so
the one who drinks water should think of
the one who dug the well supposedly a
chinese philosopher who knows but anyway
we should remember the people that let
us get to where we are today and the one
that certainly got me here
and jim ray probably too who is our ge
person with us today was this guy dr
bill mckinney he was a neurologist the
most enthusiastic person i've ever known
he could sell ice to the eskimos and
make them grateful for it
he went on to become the president of
the american institute of ultrasound in
medicine and pulled many many people
some kicking and screaming like me into
this field and we're very grateful to
him for that
dr mckinney died not too many years ago
this was a gathering just before his
death
to honor his career at bowman gray wake
forest where he spent his entire career
you can see me in the picture but you
can also see dr kim in the picture long
before we had any idea we'd be fortunate
enough enough to have him as a colleague
at texas tech so this was 10 years ago
okay sonar
you ain't got a thing if you ain't got
that ping if you're
familiar with that well anyway
the sonar equipment that was used in
world war ii obviously like with most
things military they made a lot more of
it than it turned out we needed
the war ended and there was always
surplus equipment around this was
actually a submarine i got to visit in
san francisco that's now a museum and
you can see the sonar equipment just
racks of equipment here and this allowed
you to steer the
transducer which is this thing up on the
deck so this pipe went up came up here
and if you turn this wheel you can
actually point this thing in different
directions you had to do that manually
and then you could record
the intensity of any incoming
information and maybe figure out that
there was another sub or a ship on the
surface out there
well that same equipment ended up this
is at the university of colorado back in
the
1960s you can see the same equipment
basically in this rack over here and
they borrowed this gun turret and filled
it with water and whatever they wanted
to scan since it was sonar they figured
it had to be submersed in water so their
subjects are holding lead weights to
keep them from floating up this actually
made pretty good pictures they had this
automated transducer array that went
around oscillating as it went around it
would make pictures of the neck and you
can see all the strap muscles and the
vessels everything else is really
impressive but obviously not very
practical for day-to-day patient care
well in the evolution of things this
life magazine article also from the 60s
from honeman
shows a lady getting an ultrasound scan
in pregnancy and you can see there's
this plastic bag filled with water so we
still have what's called the water path
concept and the displays fetal head is
here on an oscilloscope screen that was
still pretty amazing because you could
tell some things you couldn't tell
before presentation if you weren't
successful with your leopold maneuvers
and figuring out the position well then
the equipment went on to become what we
call contact b scanners they found that
you could get rid of the water path and
just make contact directly with the skin
and this is me many years and a lot more
hair ago and if you look carefully up in
the edge that's jim ray who's your next
speaker so we came out of the same
training program i did not have anything
to do with getting him here today but i
am so glad because he is of all the
people in the world that know the logic
e there's just nobody better so we're
very fortunate to have jim with us today
well when i first came out here in 1977
that's jim ray again he was one of my
first two sonographers so our track
record goes way back again what we're
using here is a contact b scanner i had
an arm that came out an articulated arm
that would keep track of where in space
you were pointed it was certainly not
moving pictures you just constructed an
image by moving this thing across the
body rather like an etch a sketch
and made fairly good pictures though
that one was actually by now had
16 or maybe even 32 shades of grey so
you could differentiate for example
fluid or a bladder
from tissue like liver
really not a bad piece of equipment
by the mid 1990s we had this unit which
was from toshiba but the thing to notice
is it has two monitors on it by this
time we have real-time moving pictures
and we'll talk about how you do that
when we get to transducers in a minute
but it had to have the two monitors
because by now we were doing color
doppler the color monitors at the time
were not high enough resolution to
display the grayscale images so you
actually had to have one one monitor for
the gray information and one for color
information and this thing obviously is
the size of a of a good sized washing
machine
well
even before that people have been trying
to miniaturize things this has actually
what's called a linear array transducer
built into it and it would make moving
pictures on this little two inch
maybe three or four shades of gray
screen and it was used at the bedside to
look at heart or maybe fetal
presentation or something like that it
was battery powered but the battery only
lasted a couple of hours just never
quite caught on just wasn't quite good
enough for the job
well by the
oh within the last five or six years a
lot of the manufacturers including ge
started coming out with what basically
looked like laptop computers that have
remarkable capabilities
again by now the screen resolution is
good enough that we can do color and
grayscale on the same screen
and the controls are very logically laid
out maybe that's why it's called the
logic
whatever these logic e as in emergency i
guess
and so they started finding use like
this from the olympics back in 2008
where you know looking for
musculoskeletal injuries joint effusions
things like that you could just have it
right out there and
ready for immediate use without having
to ship the person back to some central
facility
and then they got smaller and smaller
and certainly a lot of the manufacturers
now have handheld
units and some of them actually the
quality is is not bad for if it's being
used for the right purpose they can't
compete with the bigger equipment
completely
this just announced this past november
at the radiologic society of north
america meeting
is this little unit from siemens that's
under the accuson brand name
the thing about this is the transducer
over here has no cord so this is
essentially bluetooth on steroids it
uses a very high frequency radio band so
that it doesn't interfere with other
equipment in the hospital now why would
you want to do that well it's just nice
to get rid of the cord for one thing
like in any of the bluetooth
applications but the other thing is in
say you want to use it in surgery in the
sterile field you can just slip this
little transducer sterilize it first
clean it put it in a sterile plastic bag
and then you actually have the controls
that work the equipment on the surface
so you've got everything right there no
cord to contaminate or drag across
things so
people keep coming up with clever ideas
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