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Equipment History in Ultrasound/ Echocardiography ThreadFrom: Gerson Lichtenberg (gersonsl@aol.com)Sat Jun 2 00:05:37 2001
Okay Terry, how about a round of equipment history in the echocardiography arena? While I graduated from school at Downstate Medical Center in 1979 and became registered in multiple areas, cardiac clearly became my love. As a student, I first used a SmithKline M-mode system at the Public Health Service Hospital on Staten Island, NY. This used the pink paper which came out of the stripchart recorder blank and developed under any flourescent light. They were a beta site for an early mechanical 2-D system, but really had no idea of what to do with it. So I sat for hours in a very dark room that had originally been part of a cardiac cath lab used to do cardiac work-ups on the original 7 astronauts. As I watched over Harriette Moran's shoulder, I sometimes had to keep myself from nodding off as the M-mode persistence screen swept over and over, hypnotizing me! Next I rotated through the lab at Beth Israel Medical Center in NYC, using a Unirad Echoscope 100 M-mode system. In another room, Dr. Marvin Berger did all of the 2-D exams on a refrigerator sized Varian system. The recording system was actually on a separate cart. The Unirad M-mode would sweep across the screen, stop for a couple of seconds and then sweep again. This lab scanned right handed where my prior one had been lefty. Going there once or twice a week for ten weeks, I never once produced a usable M-mode image!!! Had I not gone back to Harriette's lab the next rotation, I might never have believed that I could learn to do echocardiography! Strangely, my first cardiac job at Maimonides Medical Center in Brooklyn had me using an identical Unirad. Luckily, the Unirad was replaced about a month later with the Irex System II, the best M-mode ever produced. I had had an opportunity to use the earlier first generation Irex M-mode System. To re-load its strip chart recorder, you had to lift a very hot heating element and, I believe, fill a liquid trough with some deveolping fluid. This was a great improvement as the image came out fully developed and permanent. The image on the older pink paper continued to develop and would eventually fade after years. The System II also tried to innovate with a 3.5 focused transducer, a version of an Automatic Gain system, a pericardial enhancement feature, etc. It still had a small A-mode screen on it as well. Next, I used Irex’ System IIIB, a somewhat crude phased array imager (?32 channel?) that included the first CW and PW module made by Vingmed. I believe that the Doppler was recorded only on paper and was viewed along with the M-mode on a persistence screen next to the 2-D TV monitor. This was the system that first made CW and PW cardiac Doppler available to the basic clinical lab. Irex had to compete with ATL to convince the world that CW has benefits over High PRF PW. And then came the illustrious Irex Meridian!!!!! Using parallel processing, it produced gray scale images well above the quality of other units. In addition, it had an upgraded Vingmed Doppler module (the PCD-4) with tremendous sensitivity. Who knows what future generations of this technology would have brought! Shortly afterwards, Irex began to market the Aloka 880 color flow unit in the United States. The next generation of the Meridian would certainly have incorporated color flow technology, but the company (then owned by Johnson & Johnson) was suddenly sold to General Electric who promptly closed down the product line and simply continued the service organization. This left the cardiac market wide open to Hewlett Packard to become the dominant force. However, they were somewhat slow to come out with color flow technology, so Aloka and Toshiba had some time to penetrate the market. At my next stop, I worked at the University of Rochester (NY) where we got Toshiba’s first generation color system, the SSH-65. It was large and tended to loosen its boards if we did portables with it. The Echocardiography Lab was split between radiology and cardiology, with cardiology run by Dr. Richard Meltzer (a contrast echo researcher) and radiology run by Dr. Raymond Gramiak, a pioneer in ultrasound. In the 1960’s, he participated in the early applications of ultrasound to the heart. In the basement, he still had his original M-mode machine. It was actually a Picker A-mode, B-mode system from before the days of strip chart recorders. Instead of just taking Polaroids, they had mounted a cine camera set to scroll film slowly past a stationary line of B-mode information. This, of course, then had to be processed in an x-ray processor. In addition to Dr. Gramiak was Dr. Jarle Holen, the radiologist and mechanical engineer in fluid dynamics who had derived the formula that makes Doppler useful for estimating pressure gradients. For their Dopplers, they used a Vingmed system, I believe the one called “Alfred.” Could I really be remembering that correctly?? It was never really marketed in this country, however Dr. Holen had contacts in Norway where he had done his original Doppler work.
>From the university, I did my first mobile echocardiography in 1987. I In about 1989, Acuson (founded by Sam Mazlak, a former Hewlett Packard engineer), which during the past 5 years had swept the radiology ultrasound market with a whole new level of high resolution scanners, entered the cardiology market. Even when they first appeared at a national cardiology convention (I don’t remember whether it was AHA or ACC.), their booth was jam packed. This was a sign of their great marketing as they were totally unknown in the echocardiography community! In 1990, I took a break from hospitals and went to work for Biosound which was marketing the Italian Esaote Biomedica products called the Genesis line (using annular array technology). They had just come out with a rather remarkable color flow system in a 40 pound box. It was not meant to compete with the full size systems, but rather to open up the office, small hospital and mobile markets. Within a year, it also had a contained stress echo package, a feat which took the major companies most of the decade to attain. It was an excellent package for true digital acquisition. It even was able to adjust the frame rate of the scanner to the detected heart rate, thereby making the pre- and post-stress images appear to be at approximately the same heart rate! In 1994, after having a year as Biosound’s top sales rep, I went to work for Interspec just as they were being bought by ATL. Interspec had made its name with small systems designed for the private office, then bought Vingmed to obtain Doppler technology, then combined the technologies into the Apogee systems. These were annular array systems which advanced into the color era, had a high resolution TEE probe and generally enjoyed a strong reputation in the cardiology market. Interspec became ATL’s cardiology division, eventually getting a version of the HDI 3000 to sell as a high end cardiology unit. This system was highly software controlled, enabling it to easily enter the harmonics age. Their harmonics software was initially designed to use the newly emerging sonicated contrast products, but as soon as Acuson introduced harmonics for improved tissue imaging the ATL product was easily adapted to this application. In parallel to the ultrasound system market was another line of products for digital acquisition and stress echocardiography. This initially began in about 1984 with two companies, Franklin and Microsonics starting the market. Franklin quickly disappeared and Microsonics entered some rocky financial times. Microsonics was sold to an entrepreneur named Larry Lee who was unable to turn it into a profitable company. Another company, Nova Microsystems, was started in about 1987 by 3 former employees of Irex (Tom Williams, Dennis Schubert and Aaron Waitz) who were left without jobs after the sudden closing of Irex. Within a couple of years both Nova Microsystems and Microsonics were bought by ATL and combined to form Nova Microsonics. Meanwhile, John Freeland, the founder of Microsonics, started another company under his own name. These two companies competed for a number of years, along with some other small players like Dextra. They formed alliances with ultrasound manufacturers, providing black boxes which could be interfaced within the frames of the ultrasound machines themselves. As the ultrasound manufacturers finally came to design their own truly integrated direct digital acquisition packages, this market started to go away in the late 1990’s. Nova Microsonics was sold by ATL to Kodak to try to get into other aspects of the digital storage market, but eventually went away entirely. Freeland sold his company to TomTec, a company largely involved in 3-D reconstruction technology, and eventually disappeared from this market as well. Well, this is an overview of my recollections from the 1970’s, 1980’s and 1990’s. It is, of course, only a portion of what actually went on. Many other companies came and went....... anybody remember Delmar, Life Technologies, periodic entries from Diasonics?? I hope this is entertaining for some, useful for others! Good luck to one and all!
-- Gerson S. Lichtenberg, RDCS, RDMS, APS Cardiology Department Oak Park Hospital Oak Park, Illinois
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