During the s, efforts to use reflective techniques were made, which of course required that the receiver was on the same side of the material as the transmitter. Donald Sproule , a researcher working in England in created a system in which the receiver was a separate device collecting the waves that had bounced off the material. In , Floyd Firestone , working in the US, received a patent for the Reflectoscope, the first system in which the same transducer both generated the ultrasound waves, and also detected the reflected waves, in the time between transmitted wave pulses.
In , Karl Dussik , an Austrian physician, and his brother Friederick , a physicist, introduced hyperphonography, a technique which used ultrasound to visualize the cerebral ventricles. Unfortunately, W Guttner, working in Germany showed that the apparent 'pictures' of ventricles were nothing of the kind, but instead represented densities of different parts of the overlying skull!
George Ludwig , working at the Naval Military Research Institute, in the United States, in , carried out research into gallstones embedded in soft tissues, using a through transmission technique. His pioneering investigations into the interactions between ultrasonic waves and animal tissues, helped lay the foundations for the later successful use of ultrasound in medical practice. Ian Donald introduced the ultrasound in diagnostic and medicine in , when he used the one-dimensional A-mode amplitude mode to measure the parietal diameter of the fetal head.
Two years later, Donald and Brown presented the ultrasound image of a female genital tumor. A decade later the Doppler effect served as the basis for the construction of the device that enabled the visualization of blood circulation, color flow Doppler ultrasound. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait.
Unable to process the form. Check for errors and try again. Thank you for updating your details. From the parasternal approach, Doppler signals of about Hz were obtained in presystole, systole, and early diastole, indicating atrial contraction, ventricular contraction, and ventricular relaxation, respectively [ 2 ]. Using a low-pass filter and a band-pass filter added to the Doppler frequencies amplifier it was possible to distinguish the Doppler signals produced by the movement of the heart wall and valve, and, further, Doppler signals originating from a diseased heart.
They also developed a more coherent and complete recording of heart activity by recording Doppler signals simultaneously with the electrocardiogram and phonocardiogram on oscillograph paper.
Information on valve movement - previously unavailable without invasive tools - and aspects linked to myocardial excitation were obtained and analysed [ 3 ].
At an international meeting in London held 3 years later The 3rd International Conference on Medical Electronics , they named the above mentioned equipment Ultrasonic Doppler Cardiograph [ 4 ]. As part of his doctor of medical science thesis, Satomura working with the neurologist Ziro Zaneko used a newly built Doppler flowmeter to produce data on blood flow velocities in peripheral and extracranial brain supplying vessels using ultrasound. They proved that ultrasonic Doppler signals from arteries and veins can be recorded from the surface of the skin and pioneered transcutaneous flow analysis in systole and diastole in both normal and diseased blood vessels [ 5 ].
It was postulated that, while the Doppler flowmeter could not measure quantitative blood flow volume, it could qualitatively examine the characteristic rheological changes of blood flow in various clinical conditions. In recognition of his new interest in medicine and full dedication to developing engineering tools for medical applications, Satomura was awarded the degree of Doctor in Medical Sciences in Unfortunately, at the age of 41, in the midst of working to prove his ideas and to finish his ongoing research, this bright-minded and hard-working man passed away suddenly due to a subarachnoid haemorrhage.
Satomura considered that the Doppler signals were generated from turbulent flow in the blood vessels like the noise heard through a stethoscope, it was later clarified by Kanemasa Kato Osaka , that in fact the flow signals originated from reflections from the red blood cells moving simultaneously at different velocities.
In addition, it was shown that the wave frequency shift was proportional to the velocity of the flow and that the magnitude of the voltage output corresponded to the number of red blood cells [ 7 ].
One of the early criticisms of the Doppler flowmeter, its inability to detect flow direction, was overcome by Kato and Izumi who developed in the first directional flow-meter [ 8 ]. Because Japanese reports were almost exclusively written in Japanese, the benefits of shared data were not used. They later reported transcutaneous Doppler flow detection as a non-invasive technique in Independently of the Osaka group, McLeod developed in the directional Doppler [ 11 , 12 ].
The pulsed Doppler technique was developed almost simultaneously by Wells in the UK and Peronneau et al. An important step toward spreading Doppler technique in clinical practice was represented by its combination with 2D imaging with the development of ultrasonic duplex echo-Doppler scanner by Frank Barber in [ 14 ]. Another breakthrough came when Holen and then Hatle demonstrated that hemodynamic data in patients with mitral stenosis and aortic stenosis respectively can be accurately determined with Doppler ultrasound by using the Bernoulli equation [ 15 ].
Shigeo Satomura discoveries were the first medical applications of Doppler sonography and impressive technologic innovations have been continuing ever since. Coman IM. Christian Andreas Doppler: the man and his legacy. Eur J Echocardiogr. A new method of mechanical vibration measurement and its application. Google Scholar. Satomura S. Ultrasonic Doppler method for the inspection of cardiac functions.
J Acoust Soc Am. Article Google Scholar. Studies on peripheral circulation with ultrasonics. Abstract of the 65th Meeting of Kinki Psychiat. In addition we have received a rare video of the first demonstration of color Doppler. This rare video was provided to us by Geoff Stevenson, MD, who was also involved in the early developments and medical use of Doppler shifted ultrasonic energy. This video was in the archives at the University of Washington. Geoff and I met at a meeting of the American Registry of Diagnostic Medical Sonographers and he told me about the existence of this rare film.
Doppler has come to be used in almost every medical discipline for the study of blood flow, tissue motion, and disease processes involved in these dynamic processes. The development of real time scanning was a great democratising influence in obstetric scanning which was no longer confined to an elite group of experts in a few major centres. Real time scanners being inexpensive were now widely available and many experienced practitioners of static scanning were surprised and not a little discomfited at how quickly their junior doctors, midwives and sonographers became experts in scanning almost overnight.
Fetal biometry: The ease with which the probe could be manipulated meant that many fetal structures were measured and a great number of charts of different planes and organs were developed. For example charts of inter-orbital diameter Mayden et al. However the standard measurements CRL, BPD, head circumference and abdomen circumference which were developed during the static era remained the standard fetal biometric measurements for assessing growth with only the addition of the femur length which was now easier to measure incorporated into equations for fetal weight and growth predictions Hadlock et al.
Fetal activity: Studies of fetal behaviour were inspired by leaders in development biology such as Geoffrey Dawes in Oxford and Heinz Prechtl in Nijmegan. The ability to follow fetal movements by ultrasound inspired much interest as to whether quantification of these movements and especially fetal breathing movements might be helpful in assessing fetal wellbeing.
The time, incidence and number of movement episodes or fetal breaths were quantitatively assessed and behavioural states identified. Although there was an association between reduced total activity and IUGR, the test had a low predictive value for a positive test due to the large physiological variation in the incidence of both breathing and motor activity Marsal, For this reason in Europe the measurement of fetal activity fell out of favour as a means of assessing fetal well being.
In USA however Frank Manning and Larry Platt in incorporated both of these measures into a 30 minute fetal biophysical profile test Manning et al. This test with minor modifications became the mainstay of fetal wellbeing assessment in the United States for over 20 years. In Europe however researchers turned increasingly to Doppler Ultrasound to solve the problem as to how to effectively assess fetal wellbeing and optimise the timing of delivery when there is fetal compromise.
Fitzgerald and John Drumm from Dublin using 2D static scans to identify where the probe should be placed but neither of these two groups followed up their observations. Two groups initiated pulsed Doppler studies of the fetus. In Australia, Robert Gill working with the Kossoff group measured flow velocity in the umbilical vein Gill et al.
However the long path length of the Octason prevented the measurement of high velocity arterial flow and this system was impractical for clinical Doppler studies. He measured flow velocities from the fetal aorta and found that they were reduced in IUGR fetuses.
It was found that absolute velocity measurements were inferior to waveform analysis especially the pulsatility index in the assessment changes in the fetal circulation to hypoxia.
In Australia Brian Trudinger and Warwick Giles rediscovered the importance of the umbilical artery waveform and established the significance of absent and reversed end diastolic flow Trudinger et al. In Campbell and his group described the uterine artery waveform and the appearance of notching which together with a high resistance index was associated with pre-eclampsia Campbell et al. His group subsequently used this finding to screen the pregnant population at 24 weeks gestation to predict the subsequent development of preeclampsia.
The advent of colour Doppler as an integral part of the ultrasound machine made visualisation of fetal vessels much easier and studies of virtually every fetal artery such as the renal, splanchnic, cerebral was investigated and charts made of the gestational changes of PI under different clinical circumstances. Although these were useful they were no better than the antenatal CTG in determining the optimal time to deliver the compromised fetus.
This led to several groups investigating the venous side of the fetal circulation. Initial studies concentrated on the inferior vena cava but in in a landmark Lancet paper, Torvid Kiserud from the Eik-Nes group in Trontheim, Norway described the measurement of the pulsatility of the ductus venosus Kiserud et al.
With modern equipment, Doppler evaluation of the fetal circulation especially umbilical and middle cerebral arteries and ductus venosus is now established as a fundamental requirement in the assessment of fetal wellbeing and the timing of delivery of the compromised fetus. A further important use of Doppler was its use as non-invasive method of diagnosing anaemia in Rh immunised fetuses which was popularised by Giancarlo Mari and the group at Yale University following a paper in the New England journal of Medicine in Mari et al.
The prediction of pre-eclampsia and IUGR by uterine artery Doppler was further explored by Nicolaides in a very large multicentre studies. One of the problems is that prevention by agents such as low dose aspirin does not seem to be effective. Nicolaides and others are now exploring the possibility of screening for pre-eclampsia in the first trimester when preventive therapy appears to be effective using uterine artery Doppler and biochemical markers such as PlGF and PAPP-A Akolekar et al.
Preterm birth: Preterm labour is the greatest cause of neonatal death and handicap and the care of the preterm baby is hugely expensive. Although the causes of spontaneous pre-term labour are many and not fully understood, a common final pathway is shortening and effacement of the cervix.
Frank Andersen from Ann Arbor Michigan was the first to draw attention to the superiority of transvaginal scanning Andersen et al. Unfortunately cervical cerclage does not appear to be effective in extending gestation in these women but two major studies from the Nicolaides group in London and the group of Robert Romero at Wayne State University, Detroit have demonstrated that following universal screening between 19 and 24 weeks, a significant prolongation of gestation in women with a sonographic shortened cervix can be achieved with daily vaginal progesterone treatment Romero et al.
Fetal abnormality screening: Following the introduction of real time scanning there was a large number of review papers documenting the experience of tertiary centres in diagnosing a wide range of abnormalities of virtually every organ of the fetal body. Many of the studies published at this time were invalid because of low ascertainment of anomalies in the newborn the prevalence should be between 2 and 3 per cent. Multicentre studies as a rule had lower detection rates than those from single centres.
Fetal Cardiac defects: For the first time the diagnosis of cardiac abnormalities was now possible. In her classic study Allan Allan et al. In S-J Yoo Yoo et al. In Beryl Benacerraf and her group in Boston first described that an increased nuchal skin fold measurement in the second trimester was associated with Down syndrome Benacerraf et al.
For the first time younger women could be offered amniocentesis on the basis of a combination of markers. Nicolaides, With CVS being offered as the diagnostic test to women at increased risk, this screening programme has been adopted throughout the world. However this is likely to change with the advent of cell-free DNA testing Lo et al. Furthermore in the future cfDNA is likely to be able to screen for a wide range of chromosome and genetic disorders. Invasive procedures: The importance of identifying the position of the needle during amniocentesis was first highlighted by Jens Bang in Copenhagen in Bang and Northeved, during the static scan era but few practitioners used his transducer with a central hole and scans at this time were usually used to identify a placenta-free accessible pool of fluid prior to the procedure.
The advent of real time scanning allowed the performance of invasive procedures under continuous vision thus reducing bloody taps and avoiding placental, cord or fetal injury.
In fetoscopy was introduced by John Hobbins and Maurice Mahoney at Yale for the prenatal diagnosis of haemoglobinopathies Hobbins and Mahoney, from fetal red blood cells obtained from the chorionic plate. However in Fernand Daffos and co-workers from Paris introduced pure fetal blood sampling from the cord insertion by direct ultrasound guided needling using two operators Daffos et al.
He and his team used this technique to assess the severity of fetal anaemia in rhesus disease thus supplanting the old method based on bilirubin measurements in the amniotic fluid Nicolaides et al.
Nicolaides and others such as Giorgio Pardi in Milan also used this technique to assess aspects of fetal acid base status and biochemistry in the IUGR fetus Pardi et al.
Another nail in the coffin for fetoscopy came with the introduction of transabdominal first trimester fine needle aspiration of chorionic villi CVS by Steen Smidt-Jensen and Hahnemann in Smidt-Jensen et al.
Fetal Therapy: The treatment of severe rhesus disease in the fetus by intraperitoneal transfusion under x-ray guidance was pioneered by Lilley in Access to the fetal circulation however prompted the development of therapeutic procedures firstly by fetoscopy Rodeck et al. Ultrasound controlled needling procedures were also used to insert shunts to decompress obstructions in the urinary tract and cerebral ventricles or to drain fluid from pleural effusions but none of these procedures were found to significantly improve outcome and in the case of ventriculomegaly, the condition was frequently made worse.
Two prenatal surgical procedures that have been shown to be useful involve the combined use of ultrasound and fetoscopy. Before this visualisation of the pelvic organs required the patient to have a distended bladder which not only frequently caused her distress but often pushed the structure of interest beyond the focal distance of the transducer.
Despite this important studies were made with the static scanners. In Joachim Hackeloer a German doctor working on sabbatical in Glasgow published his classic paper on the tracking of ovarian follicular growth Hackeloer and Robinson, and showed a correlation between follicular size and serum oestradiol. However the advent of transvaginal sonography changed the diagnostic impact of ultrasound in gynaecology.
The direct diagnosis of ectopic pregnancy was also revolutionised by transvaginal probe. Pelvic masses: TVS allowed greater discrimination between benign and malignant masses and there were several attempts to create a scoring system of morphological parameters to better define the differential diagnosis.
Anil Tailor from the same group developed a multiple regression model incorporating morphological and blood flow criteria. While these models have provided useful information they have not been shown to be superior to the subjective evaluation by an experienced observer in differentiating benign from malignant tumours. Screening for malignancy: Ovarian cancer has the highest mortality rate of all gynaecological cancers because it is symptom free in its early stages.
In Ian Jacobs at University College London introduced the concept of multimodal ovarian cancer screening in which serial CA measurements were used as the screening test backed up by TVS in screen positive cases to reduce the false positive rate. Reproductive medicine: The advent of TVS transformed reproductive medicine especially the monitoring and procedures associated with IVF. In Wilfred Feichtinger and Pieter Kemeter from Vienna described transvaginal oocyte aspiration with a needle guide attached to the transvaginal probe Feichtinger and Kemeter, and this has now become the standard technique.
Transvaginal ultrasound has proved to be reliable in assessing ovarian reserve through measurement of the antral follicle count which was first described by Reuss and colleagues in in Columbia University, New York Reuss et al. Doppler has also been used to assess ovarian reserve by measurement of stromal flow and follicular competence and maturity by measurement of peri-follicular blood flow Nargund et al.
The advent of 3D ultrasound imaging has led to a flurry of publications extolling the virtues of this new modality yet substantial evidence of definitive benefit is hard to obtain. Most fetal anomalies can be detected by high resolution 2D ultrasound and most practitioners report that the addition of 3D is rarely required.
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