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1. a Short History of the Developments of Ultrasound in Obstetrics and Gynecology

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1. a Short History of the Developments of Ultrasound in Obstetrics and Gynecology 1. A SHORT HISTORY OF THE DEVELOPMENTS OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY Dr. Joseph Woo The term SONAR refers to Sound Navigation and Ranging. As early as 1822, Daniel Colladen, a Swiss physicist, had used an underwater bell in an attempt to calculate the speed of sound in the waters of Lake Geneva. Other early attempts at mapping the ocean-floor basing on simple echo-sounding methods were nevertheless unrewarding. Lord Rayleigh in England published in 1877 the famous treatise "The Theory of Sound" in which the fundamental physics of sound vibrations (waves), transmission and refraction were clearly delineated. The breakthrough in echo-sounding techniques came when the piezoelectric effect in certain crystals was discovered by Pierre Curie and his brother Jacques Curie in France in 1880. They observed that an electric potential would be produced when mechanical pressure was exerted on a quartz crystal such as the Rochelle salt (sodium potassium tartrate tetrahydrate) and conversely, the application of an electric charge would produce deformation in the crystal and causing it to vibrate. It was then possible for the generation and reception of 'ultra'-sounds that are in the frequency range of millions of cycles per second (megahertz) which could be employed in echo sounding devices. Underwater detection systems were developed after the Titanic sank in 1912 and for the purpose of underwater navigation by submarines in World war I. The first patent for an under-water echo ranging sonar was filed at the British Patent Office by LF Richardson, one month after the sinking of the Titanic. The first working sonar system was designed and built in the United States by Canadian Reginald A Fessenden in 1914. The Fessenden sonar could detect icebergs up to two miles away, and it was also used for signaling submarines. Between 1914 and 1918 SONAR was in great demand for the detection of German submarines in the waters. Paul Langévin, an emminent French physicist in Paris, together with Constantin Chilowsky, a Russian living in Switzerland, started to develop a powerful ultrasonic echo-sounding device in 1915, which they called the 'hydrophone', and formed the basis for the development of medical pulse-echo SONAR in later years. By about the early 1930s, with the developments from Langévin's laboratory, many French ocean liners were equipped with underwater echo-sounding range display systems. World war II saw further developments in naval and military radar (using electromagnetic waves rather than ultrasound) equipments, and faster electronics, which had facilitated enormously the design of SONAR and ultrasonic detector devices in later years. Two other engineering advances have also influenced significantly the development of SONAR: the first digital computer (the Electronic Numerical Integrator and Computer -- the ENIAC) constructed at the University of Pennsylvania in 1945, and the invention of the point-contact transistor in 1947 at AT & T's Bell Laboratories. Another parallel development in ultrasonics which had started in the 1930's was the construction of pulsed-echo ultrasonic metal flaw detectors, particularly relevant at that time was the check on the integrity of metal hulls of large ships and the armour plates of battle tanks. The concept of ultrasonic metal flaw detection was first suggested by Soviet scientist Sergei Y Sokolov in 1928 at the Electrotechnical Institute of Leningrad. Early pioneers of such devices were Floyd A Firestone at the University of Michigan, and C H Desch and Donald Sproule in England. Firestone produced his patented "supersonic reflectoscope" in 1941. Messrs. Kelvin and Huges® in England, where Sproule was working, had also produced one of the earliest pulse-echo metal flaw detectors, the M1. Josef and Herbert Krautkrämer produced their first German version in Köln in 1949. These were then quickly followed by improved versions from Siemens® of Germany (Lutsch bei Siemens) and KretzTechnik® of Austria. Subsequent refinements had led to equipments operating at higher frequencies and with shorter pulse durations, resulting in finer resolution. The availability of very high input impedance amplifiers built from improved quality electrometer tubes in the early 1950s enabled engineers to greatly amplify their signals to improve sensitivity and stability in their commercial equipments. These reflectoscopes became the precursors of subsequent pulsed-echo medical ultrasonic devices operating in the unidirectional A-mode and had been used as early as 1950 by Lars Leksell in Sweden and JC Turner in London for examining brain lesions and Inge Edler and Carl Hellmuth Hertz in producing their first cardiac M-mode tracings in 1953. The Japanese were also active at investigating and producing similar ultrasonic devices but their findings have only been sparsely documented in the English literature. The history of ultrasonics in Japan probably dated back to war time in the late 1910s. Readers are referred to an important article by Dr William O'Brien, Jr. which also looks at the early history of the developments of ultrasonics. Aside from it's use in under-water navigation and metal flaw detection, the early use of Ultrasonics in the field of medicine was largely confined to it's application in therapy rather than diagnosis, utilising it's heating and disruptive effects on animal tissues. It was not until the early 1940s that attempts were made to employ ultrasound as a diagnostic tool. Karl Theodore Dussik, a neurologist/psychiatrist at the University of Vienna, Austria was generally regarded as the first physician to have employed ultrasound in medical diagnosis. He, together with his brother Friederich, a physicist, located brain tumors and the cerebral ventricles by measuring the transmission of ultrasound beam through the head, empolying a tranducer on either side. He published his technique in 1942 in his paper: "Hyperphonography of the Brain". He was not quite successful with his technique at that time largely because the skull absorbed much of the ultrasound energy used and there was also technical inadequacies in recording the results generated. His efforts however, had inspired and influenced much of the later work from the United States, particularly those from the Massachusetts Institute of Technology. George Ludwig, a physician at the University of Pennsylvania, was one the first pioneers in the late 1940's to have used pulsed-echo ultrasound on animal tissues. In colaboration with F Struthers, Ludwig investigated the detection of gallstones using ultrasound, the stones being first embedded in the muscles of animals. His work at the Bioacoustics laboratory of the Massachusetts Institute of Technology with physicist/engineer RH Bolt, physician HT Ballantine and engineer Theodor Hueter from Siemens, Germany had enabled the measurement of the velocity of sound transmission in animal soft tissues which he determined to be between 1500 and 1600 meters per second. They did experiments with through transmission on both sides of the skull similar to that of Dussik's and arrived at different conclusions. At the same time the team demonstrated very importantly that 2-dimensional images can be obtained without too much distortion. The activity at MIT continued on into the 1960's and had profound influences on subsequent developments in ultrasonic instrumentations and methodology. John Julian Wild, a medical graduate of Cambridge University, England, who had immigrated to the United States after World War II ended in 1945, was one of the earliest founder of ultrasonic tissue diagnosis. Working at the Medico Technological Research Institute of Minneapolis, Minnesota, and together with Donald Neal, an engineer, Wild first published their work in 1949 on uni-directional A-mode ultrasound investigations into the thickness of surgical intestinal material and later on the diagnosis of intestinal and breast malignancies, where they concluded that the patterns of A-mode spikes were different. Wild's original vision of the application of ultrasound in medical diagnosis was more of a method of tissue diagnosis from the characteristics of different returning echos rather than as an imaging technique, that it was going to evolve into a tool that will be able to determine if a tumor would be benign or malignant. The device which they first used was one which had been designed by the U.S. Navy for training pilots in the use of the radar, with which it was possible to practise 'flying' over a tank of water covering a small scale map of enemy territory. He said in one of his papers, ' We have a tissue radar machine scaled to inches instead of miles by the use of ultrasound '. Donald Neal was soon deployed to regular naval services at the naval air base after the Korean war. John Reid, a newly graduating electrical engineer, was engaged through a grant from the National Cancer Institute as the sole engineer to build and operate Wild's ultrasonic apparatus. Wild and Reid soon built a linear hand- held B-mode instrument, a formidable technical task In those days, and were able to visualise tumours by sweeping from side to side through breast lumps. In May 1953 they produced real-time images at 15 megahertz of a 7mm cancerous growth of the breast. They had also coined their method 'echography' and 'echometry', suggesting the quantitative nature of the investigation. The following is an excerpt from the Archives of the American Institute of Ultrasound in Medicine, in which Reid wrote about their first scanning equipment: ' The first scanning machine was put together, mechanically largely by John with parts obtained through a variety of friends in Minneapolis. I was able to modify a standard test oscilloscope plug-in board. 8e were able to make our system work, make the first scanning records in the clinic, and mail a paper off to Science Magazine within the lapsed time of perhaps ten days. This contribution was accepted in early 1952 andbecame the first publication ( to my knowledge ) on intensity-modulated cross-section ultrasound imaging.
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