This was forwarded to me by Sanath Lama. If not for his e-mail I wouldn't have known this at all.
Click on this link:
https://www.youtube.com/watch?v=7aCc6cwHMHE
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Sanath,
ReplyDeleteThank you for posting this important information.
Having been in ultrasound I know that radiologists have known its benefits for 40 years. The ultrasound machines have minimized from the size of a modern fridge freezer to a ubiquitous electric shaver. Now is the time to teach in medical schools how to use ultrasound accurately and with confidence. We must commend the stethoscope into history and give it the laurels it richly deserves. The little known Frenchman who invented the Stethospcope Rene Theophile Hyacinthe Laënnec merits greater honour than he has so far received.
This takes away the status symbol of medical students as they proudly swung it round their necks. Progress always comes at a price!!!
Nihal, I totally agree with you. However the present cost is prohibitive. I was informed that it is about Au Dollars 3000 or SLR 360,000.
ReplyDeleteThe costs may decline in the future as for computers
Sanath
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ReplyDeleteSanath,
ReplyDeleteUltrasound has its limitations as you know. It is fine for soft tissues and fluid. If there is bone the sound waves will not penetrate. If there is air sound is deflected hence no image. For the lung and to a lesser extent the gut ultrasound is not helpful. So for the wheezes, crackles and bronchial breathing the humble stethoscope may still have its place. Sure for the heart sound and murmurs there are more sophisticated methods available but the stethoscope is a simple instrument for initial use.
When the hand held ultrasound machines becomes widely used they will get cheaper and smaller too. With the advances in technology an ultrasound machine the size of a pen torch will be available in the not too distant future. Even at present there are machines like pen torches used for the eye.
The advances in medicine are most remarkable. History taking is a lost art now with greater dependence on medical imaging which often gives the diagnosis.
When speaking of stethoscopes I am instantly reminded of a ward class with Ernie Peiris. One of the girls in our group whom we called "yellow bird" for her colourful sarees was presenting. Her voice was rather soft which made Ernie P call it whispering pectoriloquy.
Thank you Nihal for coming in with your expertise in this field to confirm the limitations of the Butterfly IQ - the same as any ultrasound as I suspected.
ReplyDeleteRohini
ReplyDeleteIndeed. It is ultrasound. Ultrasound has a long and distinguished history. The development of real time ultrasound has transformed medical imaging. The picture quality is exquisite. It will only get better with time.
What an enlightening conversation the above is, as is the you tube link Lama has given us! Well, well, well! These are times of ground breaking finds. And just as doctors adjusted to stethoscopes and later having almost an art in wearing it, and using it almost as a badge of honour, and finally now finding it is going to be phased out but not quite yet as Nihal points out! No doubt in time there will be the torch size US Nihal predicts but anyway, this is a great find and we have to celebrate it! Zita
ReplyDeleteI wonder if you all know when ultra sound was first used. I think it was used in Scotland to find out the fluid levels in huge barrels of beer!
ReplyDeleteSanath, I think this was how chest percussion originated .
ReplyDeleteUltrasound was developed as a variant of echolocation used by bats , whales and dolphins, and by ships. Interestingly, Ultrasound was first used in obstetrics by Ian Donald in Glasgow, whose text on obstetrics we used as a text in our final year at med school. It was a very well written text.
Rohini, you are absolutely correct. I sincerely apologise for the error. Pecussion was perhaps developed that way. Paul Langevin had used ultra sound in 1917 to detect submarines.The piezoelectric effect was discovered by Jacques and Pierre Curie in 1880.Ian Donald ,Regius Professor of Obstetrics in the University of Glasgow is credited with it's introduction to the field of medicine, dating back to the 1950s.
ReplyDeleteSanath- no worries -
DeleteThank you for the historic details you’ve provided.
Yes, sound waves had been used in World War1 to detect enemy submarines.
The history of Sonar is interesting dating back believe it or not to Leonardo da Vinci!
Rohini and Sanath
ReplyDeletePresence of fluid is the basic requirement for ultrasound imaging be it the sea or amniotic fluid. The latter makes the images exceptionally clear. I made it a point to show the pregnant ladies the face and the beating foetal heart. Without exception I saw the tears of joy. It is such memories that made my work all worthwhile. Ah!! where have all those years gone?
It is true the news is not always good. Breaking bad news is never easy.
I was there right at the beginning when Ultrasound was new, working as a registrar at Kings College London. With B-scan ultrasound the picture quality was so poor I had the greatest difficulty in convincing the surgeons a patient had gall stones. Although obstetric ultrasound was pretty well established its use for the rest of the abdomen was in its infancy. Hence it was delegated to the registrars who had to take the flack at the ever aggressive medical and surgical meetings.
The big name companies like Siemens, Toshiba and GEC realised its financial potential and rewards and continued to improve the technology and develop better machines. Then Real Time Ultrasound was born. We could see movement and get a fine 2-D image of the human anatomy. The current imaging is picture perfect !!
Ultrasound has made a tremendous difference to medical imaging and diagnosis. There is no radiation and ill effects of the procedure and can be repeated as many times as is necessary.
There is always a human fascination to look into the future. MRI and CT scan images are in black and white but is in 3D although we visualise them on a computer or hard copy in 2D. Ultrasound still is in 2D, black and white and is totally operator dependent. The ultrasonographer moves the probe in whichever direction she/he wishes to obtain a saggital, transverse or oblique view. If the images are controlled by the machine like CT and MRI they would obtain 3D images. But at the present time there is no real need for this with the other modalities being so freely available.
ReplyDeleteNow we depend on the various shades of gray to identify the anatomy and also disease. To all modalities of imaging Colour would add a 4th dimension to make the images clearer and improve the ability to identify structures more precisely.
When Television was invented no one though we could have it in colour.
As the old adage goes "a picture is worth a thousand words". The picture is interpreted by radiologists and the wording of the report is crucial to the understanding of the images.
Nihal
ReplyDeleteEchocardiograms and Doppler studies of legs, renal and uterine arteries etc show colour according to the direction of blood flow. Wondered whether colour is not available in ordinary ultrasound images because there is no need for it ?
The fascination of a real time Echocardiogram showing back-flow of blood through leaky valves is unbeatable !
Thank you for the tiny glimpse into the joys you’ve given expectant mums.
Rohini
ReplyDeleteFor Doppler and echoes colour has been introduced to show direction and speed of flow. Sadly not available for the rest of diagnostic ultrasound
Nihal, Rohini, Sanath, this is Zita taking up the rear end as usual to say, thank you for that brilliant explanation and discussion on Ultrasound! You truly enlightened me on a subject I had a sketchy, two-dimensional understanding of. So this US gadget that will eventually replace the stethoscope is likely to impart much more than one dimensional sound does by our old friend the stethoscope, although strictly, it is not just sound but its quality, character, length and other observations which the 'steth' gives us. But we have to move with time and the advancements it brings us. There is no need to be sentimental in medicine when the new method is going to add a couple more dimensions in the physical signs that help us to diagnose disease.
ReplyDelete