What might the future of ultrasound look like for OB/GYNs? A brief history of ultrasound technology reveals a wild ride so far. In 1877, the first transducers allowed sound waves to be sent, received and interpreted through piezoelectricity. In 1915, an imaging device was invented that could use those sound waves to search the ocean floor. By 1949, the first electronic scanner utilized pulsed-echo technology to view organs within the human body. The first echocardiogram of the heart was done in 1953, pulsed Doppler and duplex scanning emerged in the 1960s-1980s and the first 3D obstetric ultrasound was performed in 1986.
Practitioners today are living in the middle of this exciting timeline, and every day presents new discoveries and improvements. The last few years have revealed tools to overcome key ultrasound hurdles, but sonographers and OB/GYNs still face some challenges. To find out what the future of ultrasound and gynecological imaging might look like, researchers and clinicians should examine how ultrasound needs to change to catch up to the next generation of patients and physicians.
Doppler and 3D Advances in Ultrasound
The development of pulse Doppler ultrasound technology in the 1960s evolved into continuous-wave Doppler, pulsed-wave Doppler, color Doppler and power Doppler. These advances allowed for imaging of blood flow, waveform analysis, blood localization and mapping through the many parts and layers of the heart. It also became the go-to method of evaluation for atherosclerotic plaque in the carotid arteries and thrombosis of the deep venous system.
For gynecologists, Doppler technology is becoming valuable for diagnoses that were previously only possible through other methods. Ovarian torsion, for example, can be identified by a "whirlpool" sign on color Doppler instead of through laparoscopy.
Early 3D ultrasound was often hindered by the large volumes of data and high amount of manual processing required to provide advanced image slicing and manipulations. However, newer ultrasound technology utilizes more automation, which simplifies the process and increases the possibilities for 3D ultrasound.
Other innovations include the creation of 4D ultrasound from 3D. Adding a fourth parameter — time — allows for 3D images to be updated continually in a live video view, which is especially useful in obstetrics for fetal heart imaging in the presence of fetal motion.
Advances in both hardware and software have opened up even broader applications of 3D and 4D ultrasound, allowing for greater accuracy, increased efficiency, easier use and, as a result, wider application. Transesophageal echo, for instance, is one procedure that can be enriched with 3D ultrasound. Repairs to aortic valves, atrial septal defects, and mitral valve prolapse and regurgitation are easier with the imaging advantages provided by visualization from three different angles.
Equipment Innovations Improve Ergonomics
The ergonomics of ultrasound equipment are being closely examined these days. Time has revealed how the application of ultrasound requires specific (and sometimes extended) static and repetitive body positions and hand grips. This can cause sonographers and clinicians to experience musculoskeletal injuries such as damage to the neck, shoulders, back, wrists and biceps. If not addressed and corrected, these injuries can be severe and potentially compromise physicians' careers.
For this reason, there has long been a focus on improving the ergonomics of ultrasound equipment and training users in healthy positioning. Cables and transducers have become lighter. The grip of the transducer has also been redesigned to reduce pressure points on the hands while still being an appropriate size, ensuring a comfortable, no-pinch grip that minimizes extreme wrist positions and maximizes grip adherence.
The future of ultrasound is likely to involve the development of the wireless transducer. Although wireless transducers have several limitations regarding power supply and their ability to transfer large amount of data to the main ultrasound machine, the technology offers significant advantages by increasing portability and removing awkward and inconvenient cables.
Monitors have also undergone significant improvements over the years, becoming brighter, sharper and more adjustable. Their enhanced ability to be tilted, angled, lowered and raised lets them comfortably accommodate all different user positions while avoiding neck strain and awkward hunching of the shoulders. Brighter and of higher-resolution screens help avoid eye strain and fatigue. Improving the ergonomic aspects of ultrasound products has helped to maximize the safety, usability and functionality of these valuable medical imaging devices.
Intuitive Built-In User Features
As ultrasound imaging improves in resolution, detail and general usability, user interfaces have also become more advanced. Larger and faster digital storage has been made more accessible, and multiple user preferences are easier to modify and set. Meanwhile, viewing large images across up to four screens has resulted in much better optimized ultrasound workflows.
Workflow has also been become stronger with the development of standardized clinical terminology for diagnosing and reporting pathology. Built-in features such as the IOTA Simple Rules (for the classification of ovarian tumors) and the ADNEX risk model (used to estimate the probability that an adnexal tumor is malignant) are now standard tools on some newer ultrasound machines. Easy access to this kind of information helps to reduce the complexity of many findings and offer improved patient care.
Innovations That Benefit Trainees
During ultrasond education and training, ultrasound simulators (or phantoms) can provide hands-on practice without the need for live patient models. Simulators make it possible to introduce and review abdominal, pelvic, transvaginal, transrectal and obstetric routines with uniformity and consistency, which is extremely effective for early education in ultrasound. Ultrasound simulators have been shown to work just as well as live models for the early learning process and have become quite popular as a result.
Contrast-enhanced ultrasound provides a radiation-free, sedation-free and dynamic real-time assessment of normal and abnormal tissue perfusion with increased resolution compared with 2D ultrasound. This has been found to be an ideal imaging technique for pediatric patients when examining for blunt abdominal trauma, focal hepatic lesions, organ transplantation, pleural abnormalities and other conditions.
Having an alternative to CT and MRI studies for the pediatric population gives clinicians an edge on versatility, repeatability and the flexibility of their setting, such as the operating room, the clinical bedside or the emergency department.
Bridging Generations
Ultrasound has already been used as an innovative imaging option for decades. It has replaced more expensive, riskier and less accessible imaging modalities. Ultrasound can be used to safely image pediatric patients, view a live fetus during pregnancy, provide a dynamic assessment of the heart, guide needle placement and biopsies, do bone sonometry, measure the flow of blood in major arteries and allow for detailed, in-depth abdominal and pelvic imaging.
Ongoing advances in ultrasound machines, routines and user roles continue to place ultrasound technology at the forefront of medical imaging technology. New prototypes undergoing testing are smaller, more portable and more affordable. Some options may even be wearable, powered by only a smart phone.
Ultrasound may be ahead of us all for the foreseeable future. The technology in hand is leading the newest generation of patients and physicians into a promising future of ultrasound, medicine and healthcare innovations.
