Re: 3D ultrasound poised to revolutionize pelvic imaging

From: DuBose, Terry (DuboseTerryJ@uams.edu)
Tue Jun 28 13:03:41 2005


The knobs & buttons are a consideration. But even with 3 minute acquisition times, someone still needs to relate to the patient... I am not sure how all this is going to play out, especially with the specter of out-sourcing for over-seas interpretation.

Very interesting times.

Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM

Associate Professor & Director Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510 DuBoseTerryJ@UAMS.edu http://www.io.com/~dubose/ http://www.uams.edu/chrp/dms/default.asp http://www.obgyn.net/us/panel/panel.htm ---------------------------------------------------------------

--------------------------------------------------------------- -----Original Message----- --------------------------------------------------------------- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Alessandro Gubbini Sent: Tuesday, June 28, 2005 10:31 AM To: Multiple recipients of list ULTRASOUND Subject: Re: 3D ultrasound poised to revolutionize pelvic imaging

I have also listened to Baryl's talks during AIUM and, yes, I finally got a clear message that 3D is not just baby faces.

If the future is to collect a limited number of volumes in just few minutes I wonder what it going to happen to all those knobs/buttons which allow you to change all sort of system settings, each one of those (frequency, focus, gains etc) impacts the final quality of the collected data. Maybe you guys already rely primerly on the default settings and do not feel the need for further adjustments. Is that the case?

Alessandro

Text with no pictures

3D ultrasound poised to revolutionize pelvic imaging 9/9/2004 By: Tracie L. Thompson

Three-dimensional ultrasound offers more than an easy and accurate way to diagnose conditions of the female reproductive system. It's an opportunity for sonography to reassert itself in radiology by delivering the kinds of 3D insights previously limited to other modalities. That's the message delivered by Dr. Beryl Benacerraf, a leading researcher and clinical professor of radiology and obstetrics and gynecology at Harvard Medical School in Boston. Now that 3D technology provides ultrasound with its own reconstructed views, she said, sonography can attract more of the interest that has gone to CT and MR in recent years. "I think this is going to put ultrasound back on the map of cross-sectional imaging," Benacerraf stated in a presentation at the 2004 American Institute of Ultrasound in Medicine (AIUM) conference in Phoenix. "This provides many more opportunities for ultrasound than we have ever had before." "3D is, in my opinion, one of the most important advances in modern sonography," she continued. "And it is going to explode from here on in, because we will see an enormous amount of development of this technology." Useful in practice In her talk, Benacerraf described many specific, often very practical benefits she has found in using 3D ultrasound for pelvic imaging. For one thing, 3D lends a forgiving attitude to a modality that is notoriously operator-dependent. No longer does the ultrasound image depend on the precise probe placement: the 3D technology obtains a volume scan from which any needed view can be selected. "You don't have to lament that the patient is gone, or yell at your resident or sonographer who didn't take the right picture. You can just go back to your volume and reconstruct it," Benacerraf noted. Three-dimensional ultrasound images showing septate uteri. Images courtesy of Dr. Beryl Benacerraf. The volume data generated by 3D technology can also be acquired in less than a minute with just a few sweeps of the probe. While a physician might ordinarily choose to spend more time with the patient obtaining the best views, and less time reconstructing at the computer, the speed of 3D becomes very helpful in procedures such as sonohysterography. "Taking one picture at a time on these cases is a real drudgery for both you and the patient," Benacerraf said. "But even if you can just take one or two sweeps very quickly, I guarantee you won't have to put in that much fluid because, as you squirt your fluid, you've got your volume. You can reconstruct it, and navigate through it long after the patient's gone." Another advantage of 3D reconstructions is they are more easily downloaded and forwarded to referring physicians than traditional video clips of ultrasound exams. And they demand far less interpretive skill from the receiving physician than 2D images, Benacerraf said. Diagnostic distinctions The pelvic area reconstructions enabled by 3D also provide physicians the views they were denied in the standard image-acquisition planes, but which are, interestingly, more akin to those seen in standard medical illustrations of the female reproductive anatomy, Benacerraf said. Many of the reconstructed images also make a difference in diagnosis, she said. Foremost among these is the coronal view of the uterus, an only-in-3D image that can much more definitively distinguish the bicornuate from the septate from the unicornuate uterus. Three-dimensional ultrasound images showing submucosal fibroids. Images courtesy of Dr. Beryl Benacerraf. "These kinds of images are incredibly important, particularly for the infertility patient," said Benacerraf, noting that women with septate uteri are at much higher risk for miscarriage, preterm labor, and other adverse effects. With 3D, the sonographer can also measure the width and the depth of the septum, Benacerraf said, "which will be a very good guide for the surgeon who is going to be resecting the septum." Other instances in which 3D is helpful include identifying the presence and nature of submucosal fibroids, effectively performing a "virtual hysteroscopy." In one study of 43 patients with abnormal uterine bleeding, Benacerraf and colleagues found that a 3D coronal view of the uterus was helpful in detecting polyps or fibroids in 35% of cases. The polyps were suggested but ill-defined on 2D ultrasound, she said, and 3D clarified the findings. The same study also found that turning on the 3D capability wasn't necessary or worthwhile if the 2D scan appeared normal or showed a well-defined finding. Three-dimensional ultrasound is also useful for distinguishing hydrosalpinx and septate cysts in the uterine adnexa, and for imaging the perineum in general, Benacerraf said. Overall, she concluded, 3D ultrasound is poised to completely and permanently change the views in pelvic imaging. "(In) five to 10 years we will reminisce about viewing images only in the acquisition planes," Benacerraf predicted. And, if practitioners bring new energy to the field, 3D could also enable ultrasound to challenge the ascendancy of MRI and CT for many imaging needs, she said. "It is really up to the ultrasound community to work on this, and to demonstrate how we should scan the pelvis. Perhaps we can get a lot more information than we've ever had the opportunity to get using ultrasound," Benacerraf said. "And this will cement ultrasound's role in cross-sectional imaging in this area." By Tracie L. Thompson AuntMinnie.com staff writer September 9, 2004

-----Original Message----- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of art fougner, md Sent: Tuesday, June 28, 2005 8:07 AM To: Multiple recipients of list ULTRASOUND Subject: Re: 3D ultrasound poised to revolutionize pelvic imaging

Is there any possibility of either accessing the article sans the annoying registration page or posting the article here? I heard Beryl speak at this yr's AIUM - 3D is clearly more than cute baby pix.

art

At Mon, 27 Jun 2005, Allen Worrall wrote: >
>Bouthina Ibrahim: Here's a good 3D article: Cheryl Vance bouthina
>ibrahim wrote: THANK YOU SO MUCH CAN YOU DOWNLOAD SOME INTERESTING 3D
>INTERESTING CASES. Cheryl Vance wrote: Terry: That's a very interesting

>concept. I haven't heard of anyone doing it (that remotely) for
>ultrasound yet either...but it's likely to be commonplace in
>ultrasound's future. I don't mean to sound like a GE commercial, but
>something like this is already feasible due to GE's raw data
>acquisition capabilities. GE's ultrasound systems acquire their images
>in raw data meaning that they are fully manipulable even after the exam

>is completed/stored. Because of this capability, GE's ultrasound images

>can be sent to a LOGIQworks (type of workstation connected to PACS) for

>viewing/manipulating after the patient has left. In fact, GE is
>currently testing benefits of this technology for enhancing
>productivity in ultrasound departments (see attached white paper on
>Volume Imaging Protocol VIP). Basically VIP uses GE's raw data
>technology to take cine clips of anatomy, then once the patient has
>left manipulation can take place (viewing the anatomy in various
>sectional planes - sag/trans/coronal/oblique, changing the contrast
>resolution, etc.). This gives the int! erpreting physician the dynamic
>viewing capability that is just not possible on stored single frame
>images. The interpreting physicians feel like they are actually
>scanning the patient (via the cine clips), and beyond that, they can
>manipulate the data to view any oblique plane rather than only viewing
>the planes the originally sonographer saved. But I see it going beyond
>routine VIP imaging at an individual hospital...taking bouthina
>ibrahim's proposal one step further...the manipulable ultrasound data
>could be sent to viewing stations across the nation/globe for
>interpretation thereby allowing the on-site physicians to be able to
>perform more "hands-on" procedures. It would also give the off-site
>interpreters (like bouthina ibrahim) much more confidence while they
>view the study on-line. As for the legal issues...using this technology

>is the same within a hospital setting as it would be across the world.
>The only difference is how far away the interpreting physician is
>(which in the world of TeleRadiology doesn't pose a problem so it
>shouldn't in this setting either-right?). These of course are just my
>opinions. Please note - I now work for GE Healthcare now so my
>viewpoint may be a little skewed. I am just so excited about the future

>of ultrasound! Cheryl Vance, MA, RDMS, RVT GE Applications Specialist
>Terry DuBose wrote: Humm, interesting. I think you are the first to
>offer outsourced sonographic interpretations here. While I am not
>looking for that service, personally, it does peak my interest. How do
you see this working in the medical-legal situation in USA medicine? >Particularly since obstetric practice is so litigious in the USA.
>Interesting subject. Anyone have thoughts on this? Thanks, Terry
>bouthina ibrahim wrote: YES WITH PLEASURE I CAN DO ULTRASOUND
>INTERPRETATION AND REPORTING. "DuBose, Terry" wrote: bouthina ibrahim I

>have seen several messages from you similar to this one. I am unclear
>as to what you are trying to communicate. Do you want to do sonographic

>interpretation and reporting? Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM

>Associate Professor & Director Diagnostic Medical Sonography Program
>University of Arkansas for Medical Sciences, CHRP 4301 West Markham St.
>Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510
>DuBoseTerryJ@UAMS.edu http://www.io.com/~dubose/
>http://www.uams.edu/chrp/dms/default.asp
>http://www.obgyn.net/us/panel/panel.htm
>---------------------------------------------------------------
>Behalf Of bouthina ibrahim Sent: Thursday, June 23, 2005 11:40 AM To:
>---------------------------------------------------------------
>---------------------------------------------------------------
>---------------------------------------------------------------
>Multiple recipients of list ULTRASOUND Subject: Re: ARDMS Earns
>ANSI-ISO
>---------------------------------------------------------------
>17024 Accreditation bouthina ibrahim wrote: thank you so much iam
>---------------------------------------------------------------
>consultant radiologist post frcr london and mdrd alexanderia iam
>---------------------------------------------------------------
>interested in ultrasound general and doppleriam follow ofamerican
>instituteof ultrasound in medicin my no127764
><http://www.auntminnie.com/images/logos/logo_58_59.gif>
>
>3D ultrasound poised to revolutionize pelvic imaging Now that 3D
>technology provides ultrasound with reconstructed views, the modality
>may be poised for a major role in cross-sectional pelvic imaging,
>recouping some exams that had been relegated to CT or MRI, according to

>Dr. Beryl Benacerraf.
>Click Here to view article
><http://www.auntminnie.com/redirect/redirect.asp?ItemID=62905>
>
>This article was sent to you from cheryl1vance@yahoo.com by
>AuntMinnie.com. Click Here <http://www.auntminnie.com> to go to the
>AuntMinnie Homepage.

--
art fougner, md

"If you don't know where you are going, you will wind up somewhere else." Lawrence Peter Berra

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