The Ultrasound Specialists
A Short History of Diagnostic Medical Ultrasound

The development of Ultrasound was a continuous process that involved the efforts of a variety of different people for a variety of different reasons. We will cover just a few in our limited space but please look into the references listed for a more complete accounting and pictures. Today's ultrasound was the combined and cumulative efforts of physicians, physicists, engineers, researchers, universities, governments, conferences, training and commercial enterprises taking place all over the world. The exceptional equipment we have today profited from the this unique development and we look forward to the future of this incredible modality for looking into the body in a non-invasive, sophisticated and comparably safe way.

The diagnosis of medical problems has long been limited by the need to see inside the body. Medical instruments to overcome this problem have become a part of medical practice. A variety of scopes have been produced and the discovery of X-rays in 1895 by Wilhelm Konrad Roetgen provided a non-invasive way to look inside the body. The technique of auscultation was developed in 1761 by Viennese physician Leopold Auenbregger where he tapped on the patients chest and listed for variation in the sound. The stethoscope was invented in 1819 by R. T. H. Laennec which remains an important tool today.

French physicists Pierre and Jacques Curie discovered the principle of ultrasound in the piezoelectric effect where an electrical charge is produced by pressure on certain materials. The converse is also true that an electrical charge can create sound when applied to certain materials like quartz. Practical applications were worked on by governments during WW1 for sonar detection and more completely developed during WW2.

Soviet Physicist S. Y. Sokolov first suggested the use of ultrasound for detecting hidden flaws in 1928. The early medical applications for ultrasound were mostly therapeutic such as cancer and physical therapy. Karl Theo Dussick a neurologist/phychiatrist at the University of Vienna and his brother Freiderick a physicist attempted to locate brain tumors through the skull by measuring the transmission of an ultrasound beem through the skull, are generally considered the first to use ultrasound diagnostically. They used a two transducer technique with the transducers place on both sides of the head. In 1944 engineer Floyd Firestone patented the reflectoscope where the same transducer picked up the returning echoes between the generated pulses.

Influential texts such as L. Bergmann's Der Ultraschall in 1939 and Benson Carlin's Ultrasonics in 1949 promoted the physical principles and applications of ultrasound. The First Congress of Ultrasound in Medicine was held in 1948 in Erlangen, Germany. Two papers on diagnostic Ultrasound were given, one by Karl Dussick and one by Wolf-Dieter Keidel a physician at the University of Erlangen, along with many on Therapeutic uses.

Experimentation had also started in the United States by the late 40s. George Ludwig at the Naval Medical Research Institute in Bethesda, MD began experiments on animal tissue using an industrial ultrasonic flaw dector. Ludwigs work was not released to the public until Oct. 1949 because it was considered classified. Ludwig reported the mean velocity of sound transmission to be 1540 m/sec which is still used today.

John Wild an English surgeon that emigrated to the US after the war and John Reid an engineer built the first scanning machine and published the first paper on ultrasound imaging in 1952. He worked at the MedicoTechnological Research Institute of Minnesota and put the system together using parts obtained from a friend and a test oscilloscope. Wild and Reed also invented and described the first A-mode transrectal and transvaginal scanning transducers in 1955.

Douglas Howry a radiologist at the University of Colorado and VA Hospital published articles with 2D images in 52 and 53 using systems that featured a water bath and later a motorized transducer. Howry and Joseph Holmes a nephrologist and director of the hospital's Medical Research Lab are credited with many pioneering designs. Holmes along with engineers William Wright and Ralph Meyerdirk developed the compound contact scanner for direct contact with the patients body. Wright and Meyerdirk left to start Physionics Engineering Inc and later the multi-joint articulating arm. Physionics was acquired by Picker Corporation in 1967.

Development was also taking place in Japan as surgeons and engineers started looking into intercranial disease. MIT hosted a conference in Bioacoustics in 1952 where many of these innovators met and exchanged information. Aloka produced Japans first commercial waterbag scanner the SSD-1 in 1960 and Toshiba was soon to follow. Research and experimentation was now being done in many field all over the world with emphasis in Cardiology, Obstetrics, Neurology, Opthamology and other areas. Instrumentation was being produced by several manufacturers including Physionics/Picker, Nuclear Enterprise, Kretz Technik AG, Smith Kline Instruments, Aloka, Toshiba, Siemens and others in the 60s. Several articles appeared concerning ultrasound like the Time article in May 1964 and Life in January and September of 1965. Other important developments included the AIUM (American Institute of Ultrasound in Medicine) starting to accept members in the diagnostic arena in 1964. The Japan Society of Ultrasonics in Medicine was started in 1962. The First international Conference on Diagnostic Ultrasound was held in Pittsburgh PA in 1965 and was attended by many influential pioneers. Medical insurance companies such as Blue Cross started reimbursing for ultrasound studies in mid to late 60s. The first meeting of the World Congress on Ultrasonic Diagnostics in Medicine was held in Vienna in 1969.

The first fast B scanner the Vidoson by Siemens was developed in 1967. This system used 3 rotating transducer and a parabolic mirror and was able to scan at 15 frames per second used 120 lines and had gray scale capabilities. Motion and evidence of fetal life could be seen. The system did not have calipers or measurement capabilities like some other systems available at the time.

The concept of Linear array transducers was first described in an ophthalmic application by Werner Buschmann in 1964. It was fabricated by Kretztechnik AG but never went into production. Phillips described a multi-element scanner in 1967. One of the first commercially available linear scanners came from ADR (Advanced Diagnostic Research Corporation in 1973. Other entries came soon from companies like Aloka in 1976 followed quickly by Toshiba.

While we have discussed the medical imaging part of ultrasound so far important developments were also taking place with other ultrasound technology. The Doppler principle was first described back in 1842 by Christian Doppler. Medical uses of ultrasonic Doppler techniques were first done in Japan by the Institute of Scientific and Industrial Research for the study of cardiac valvular motion and peripheral vessels 1962. Directional flow was detected and displayed in 1966 also by the Japanese. University of Washington was also doing Doppler work and pioneered trancutanous continuous-wave flow measurement and then spectral analysis in 1963. The technology was transferred to Smith Kline Instruments and they produced the Doptone in 1965. Other early companies involved in CW Doppler devices included Parks Electronics, Kay Electric and Medasonics Inc.

Pulsed wave Doppler was introduced in 1970 where you could now identify the distance that a signal was coming from due to a selectable sample volume. The first duplex pulsed Doppler scanner was developed in 1974 where the gray scale image could be used to place the Doppler signal. This is incorporated in many of todays ultrasound systems. The first commercial Duplex system was from ATL (Advanced Technology Laboratories) the Mark1 was released in1974. Squibb Corporation acquired ATL in 1980 and ADR in 1982 and ADR was merged into ATL in 1984. Vingmed Sound AS controlled much Doppler technology and teamed up with companies like Irex, Ausonics and Interspect. Vingmed was acquired by GE later.

Doppler continued to expand capabilities at the University of Washington with color being superimposed on grayscale 2D images. Limitations in technology and processing power slowed the introduction of this technology. At the AIUM meeting in 1983 Quantum Medical Systems introduced the concept of Color image and showed the first images at the RSNA meeting in 1984. The Japanese had done much color research and Aloka actually produced the first commercial system with real time color in 1984 with the SSD-880CW in 1984 and it debuted in Medical journals in 1985. Toshiba followed with the SSH-650A. Quantum released the Quad-1 in 1986. ATL released the Ultramark 9 in 1988. Irex sold the Aloka system in the US which was acquired by Johnson and Johnson and later sold to GE. Quantum was acquired by Siemens.

Another technology that you will find in today's system is M-mode (time-motion) display. This was first described in 1954 and shows the motion on a still display. It is currently used for cardiac and fetal cardiac motion studies. It was implemented with imaging and described in 1972 with the detection of fetal cardiac motion at 7 weeks.

Over 45 ultrasound companies were doing business in the early 80s worldwide. Technologies continued to improve and image quality showed improvements in the 90s. Some of the technical improvements include Digital Signal processing, broadband wide aperture transducers, increased channels, improved materials, harmonic imaging and processing speeds. These features are on most of the systems available today and we will not take the time to go into them now but they continue to get better.

One newer ultrasound technology that is currently moving the industry is the 3D/4D (real time 3D) system. Some of the first work was Tom Brown with Soncaid Ltd that produced a prototype in 1973. Kazunori Babi of the Institute of Medical Electronics, University of Tokyo published a book with chapters on 3D ultrasound including pictures in collaboration with Aloka. The Combison 330 from Kretstechnik was the first commercial 3D scanner on the market in 1989. Medison acquired Kretztechnik in 1996 and continued to produce more advanced versions of the Voluson series. By the late 1990s over 20 centers worldwide were working on 3D technology. Other early manufacturers of 3D systems include ATL, Tom-Tec imaging Systems, GE-Vingmed, 3D-Echotech and Life Imaging Systems Inc.

As you can see Ultrasound is a vibrant and continuously improving technology. Who knows what the future may bring but the technologies from the past continue to provide important diagnostic information. If this information interests you we suggest you check out some of the references we list. They contain much more information than we have passed on here. There were many people, companies and alliances and mergers involved in getting us to where we are today. Many technologies and important advances are not even touched here. Thank you and enjoy. Please let us know of any good articles available on the web about this topic.

For more information about the history of Ultrasound you may want to visit the following Links.

A Short History of the Development of Ultrasound in Obstetrics and Gynocology
Dr John J. Wild Pioneer of Diagnostic Ultrasound
A Short History of the Development of Diagnostic Ultrasound in Japan
Development of Ultrasonic Scanning Techniques in Scotland
BMUS Scenes from the History of Ultrasound
History of the Development of Ultrasound
Developments in OB/GYN Ultrasonography in the Soviet Union
Short History of Kretztecknic
Life Magizine Early Ultrasound Articles
Ultrasound Imaging the Past 40 Years
AIUM History Timeline
Historical Ultrasound in Australia
Seeing with Sound A Study of the Development of Medical Images
Ultrasound in Medicine a Review
Tom Brown on 3D The Sonicaid Venture

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