Medison America Ultrasound

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Roberta Speyer:  “I’m here today with Dennis Wisher, he’s the Education Director for Medison America.  Dennis, tell us a little bit about what that job entails and then tell us something about Medison’s new technologies.”

Dennis Wisher:  “Medison’s new technology is three-dimensional ultrasound and one of the key things that we want to use to utilize the three-dimensional ultrasound is education.  The ultrasound market has been a two-dimensional market for the last twenty-five years, and we want to have education help integrate 3-D into the two-dimensional ultrasound market.”

Roberta Speyer:  “We hear a lot about 3-D technology from many of the different companies that have products, mostly 2-D products, but Medison’s really pioneered 3-D ultrasound.  Isn’t that correct?  What is unique and different about the 3-D technology that Medison has?”

Dennis Wisher:  “Three-dimensional ultrasound has become quite a buzz word in the ultrasound marketplace and there’s two main differences with the Medison ultrasound, one is the method of acquisition.  We’re able to acquire anatomy as volume data without having to move the transducer, and then once we acquire that data we’re actually able to quantify that data.  We can measure and calculate volume measurements in any scanned plane and this is a significant difference over any of the major other types of doing three-dimensional ultrasound such as a manual acquisition.”

Roberta Speyer:  “It seems to me that manual acquisition would require a greater degree of skill, is that correct?  There still must be a learning curve but how does the ability to gather the information with your technique make it easier for the sonographer or doctor doing the scanning?”

Dennis Wisher:  “Manual acquisition is actually the oldest of the technologies for acquiring anatomy for 3-D, and it requires the person to place the probe on the skin and to pull the probe along the skin collecting a series of two-dimensional slices.  One of the key difficulties is it’s very difficult to pull your hand at a consistent rate of speed so if you move your hand slowly, the slices of information are close together, if you move your hand faster, the slices of information are farther apart.”

Roberta Speyer:  “And if you do a little of both in the same scan?”

Dennis Wisher:  “This is what happens, you usually do a little bit of both so the resulting information that you acquire is non-uniform.  This means the distance of spacing between those slices is not known and this is a problem because if you’re going to use three-dimensional ultrasound as a diagnostic tool, you need to have a quantifiable volume data set.  This is very, very difficult to achieve if you use a manual acquisition technique.”

Roberta Speyer:  “What is your technique?”

Dennis Wisher:  “Our technique is called an automatic acquisition technique and, essentially, you simply place the probe on the patient, press one button, and within three seconds you make a three-dimensional volume data set of the anatomy that you’re looking at.  This is especially helpful when doing any type of inner cavity scanning.  When doing an endovaginal scan, you’re able to acquire the entire uterus in three seconds without lifting the transducer.  For looking at prostate examinations, we can acquire the entire prostate and seminal vesicles without moving the transducer, again, in a matter of seconds.  If you’re looking at neonatal brains, we can put the probe at the fontanel, press one button, again, and in two to three seconds make a three-dimensional copy of that brain, and we have a full volume data set of that brain that’s quantifiable.  We can move through that brain in any specific scan plane that you want, and we can imitate the planes that you would traditionally see on a cat scan or an MRI.”

Roberta Speyer:  “That’s fascinating.  We just returned from a meeting of the American Association of Gynecologic Laparoscopists down in Orlando and there were quite a few doctors discussing the use of ultrasound scanning in hysteroscopy and for diagnosis of fibroid tumors.  Since OBGYN.net has a lot of physicians that do this type of surgery that are our viewers, maybe you could share with us a little bit about how your technology can work not just for the fetal but actually for the gynecologic aspects.”

Dennis Wisher:  “Actually, this is a great question because people associate three-dimensional ultrasound with the obstetrical scan.  Many associate it with the baby face but gynecologic examinations are an excellent use of three-dimensional ultrasound.  Number one – we can acquire the uterine anatomy without moving the transducer and we can do it in a matter of seconds.  After we’ve acquired that data, we can look at it and scan planes that simply don’t exist in the two-dimensional ultrasound world.  For years everyone has looked at the endometrium in 2-D; longitudinal or transverse is part of the routine examination, and we measure endometrial thicknesses but with three-dimensional ultrasound we have a volume of that uterus.  We can look at the true shape of the endometrium, we can calculate endometrial volumes as well as being able to step through that endometrium in a plane that we call a horizontal plane that allows us, again, to see the true shape and get a better visualization of tumors, polyps, or any type of abnormality that might be present within the endometrium.”

Roberta Speyer:  “I actually had the pleasure of having dinner at the home of Professor Lewis Keith last night who is quite a well-known physician from Northwestern University here in Chicago and is very active in the International Society for Gynecologic Endoscopy and the American Association of Gynecologic Laparoscopists.  He went so far as to say he can envision a time when 3-D ultrasound scanning of the uterus will actually become part of the routine annual exam much as the Pap smear is well accepted but in its day early on it was a controversial subject on whether or not it was really necessary.  What’s your opinion on that; do you agree with that?”

Dennis Wisher:  “Actually, when you’re using three-dimensional ultrasound, again, for a gynecologic examination, it’s the perfect tool because there’s many things that you can use it for as part of the routine examination.  For years for looking at and measuring the cervix we’ve used the simple 2-D linear measurement to measure the cervix even though it’s not a linear structure.  With three-dimensional ultrasound, you can get much more accurate measurements as well as volumes of the cervix.  When we’re looking at tumors, again, within the endometrium or looking at fibroid tumors, we’re able to step through that in any scanned plane that we desire.  Also, when we’re looking at the adnexa or at masses of the ovary or any complex mass we can look at that complex mass as a three-dimensional structure and actually filet it open and look inside of the wall of that cyst or complex structure and actually see the subtle changes that are inside of that wall which are many times difficult to see on two-dimensional ultrasound.  When the physician is performing a sonohysterography, we are able to acquire that entire uterus with the saline contents in a matter of seconds, again, without moving the transducer.  So we get better patient acceptance, more volume data information, and with the gynecologic examination we get to see the anatomy and scan planes that simply don’t exist in 2-D.”

Roberta Speyer:  “There’s also applications in the area of breast exams, is there not?”

Dennis Wisher:  “Actually, that’s another good use for three-dimensional ultrasound.  A classic example of an examination would be the patient has a mammogram, they see something suspicious on the mammogram, and they order an ultrasound to see if it’s cystic or solid and to actually confirm the mass being present.  With three-dimensional ultrasound, we perform an acquisition; again, in a matter of seconds but because of that third plane, the horizontal plane, we’re able to see views of the tumor that don’t exist in two-dimensional ultrasound.  So just with the superficial work that we’ve done so far using 3-D for the breast, we’re able to see these specific views that you could not obtain on two-dimensional ultrasound.  We also have the ability to do the biopsy using three-dimensional ultrasound techniques so you get a more accurate placement of your needle whether it be a cyst aspiration or for a biopsy.”

Roberta Speyer:  “So really the application of 3-D ultrasound is very strong in the area of women’s health whether it be breast health or whether it be in areas related to pregnancy, especially high-risk pregnancy, but also in general with fibroid tumors and looking towards the future with actually just the annual exam and being able to provide better reassurance to the patients.”

Dennis Wisher:  “That’s true and one of the key reasons is because of the automatic acquisition technique.  When you’re performing your exam, if you need to do a three-dimensional portion of that examination, simply press the button and you’re in the 3-D mode.  You do your acquisition in seconds and, literally, if I was doing an endovaginal examination, in three seconds I acquire that anatomy.  I can place the probe down and simply turn the dial to get those images that I need.  The thing that’s so amazing is that in three seconds of scanning I can acquire more information than a 2-D scanner could acquire if they scanned the patient for an hour.”

Roberta Speyer:  “You’ve sold me, Dennis.  But now for our doctors that are out watching this that want to acquire one of these machines and put it in their office, how do they do that?  When you go look at the cycle for buying ultrasound equipment, they’re replacing their machines about every five to seven years?”

Dennis Wisher:  “That’s correct.”

Roberta Speyer:  “So there are physicians out there that are probably going to be watching this that are considering making a purchase sometime in the future and more than likely if they’re in that buying cycle they probably are sitting on a 2-D machine now.  Would that be a correct assumption?”

Dennis Wisher:  “That is correct.”

Roberta Speyer:  “If they’re buying a machine to put in their own office, what machines in your lineup would you recommend?  You probably have a lot of machines, tell me about the span that they run and which ones you’d recommend for the in-office obstetrician and gynecologist.  Also, add into that if there is a difference between whether or not they’re doing a lot of gynecology or they’re doing a lot of obstetrics.”

Dennis Wisher:  “For a private physician in an obstetrical or gynecologic office, the system that we’re in front of right now, the VOLUSON 530 has the core 3-D components which are, again, the automatic acquisition, the multiplanar that’s quantifiable, and 3-D rendering.”

Roberta Speyer:  “Where is this button you’ve told us about?  They set this up and they press a button here?”

Dennis Wisher:  “Essentially, all you do is press one button which is the volume button and then you do your activation and essentially the examination is acquired, again, in a matter of seconds.  One of the things that we found is even though three-dimensional ultrasound can provide a tremendous amount of information that you don’t see on 2-D, we want to make sure that people know that we’re not trying to have 3-D take the place of 2-D.  The 3-D is going to be used in conjunction with the 2-D examination and keeping that in mind, for the private practice obstetric and gynecologic physician, the VOLUSON 530 works very well in the practice for doing the obstetrical examinations as well as the routine gynecologic examinations.  One of the things that we found though is because 3-D is perceived as being a new technology many physicians are more comfortable with their standard 2-D.  What Medison has done is we have a revolutionary new program and we want the physician to experience three-dimensional ultrasound and not have to have that fear factor of - should I be in 2-D or should I be in 3-D?”

Roberta Speyer:  “How revolutionary is it?  What is it?  Tell us, I’m all ears.”

Dennis Wisher:  “What we have is a program called ‘Fee-Per-Scan’ and the Fee-Per-Scan program enables the physician to have a system put into his department with no money out of his pocket, no payment for shipping, and we also do the training as well with no payment.  When the physician performs a 2-D examination, he makes no payment to our company.  If he performs a billable 3-D scan, then he pays $100.00 for that scan.  There is no commitment to the physician.  If the physician has a system in his office and he decides 3-D is not for him, he can call us up and we’ll remove the machine so he has no financial commitments to being locked into a system.  This gives him the opportunity to use 3-D in his departments and actually see if 3-D is right for him.  In addition to that, the imaging community has the CPT code for three-dimensional ultrasound which is 76375 and that enables the physician to actually bill for his three-dimensional ultrasound as well in conjunction with conventional 2-D images.”

Roberta Speyer:  “So if I am a physician and I decide after watching this that this is interesting you can find on OBGYN.net the opportunity to contact Medison America and they can have someone come out and speak to you.  You can also reach Medison America directly by phone.  Tell us the number.”

Dennis Wisher:  “The number is 800-829-7666.”

Roberta Speyer:  “I can essentially have the opportunity to get one of these machines placed in my office.  Also, is there a training component?  I know you’re very heavy on training at Medison.   It’s going to help me see the opportunities that I can use in my practice to help enhance my practice.  Can I make money with this?”

Dennis Wisher:  “The answer is yes, you can make money with it, you can do a good quality diagnostic examination with 3-D and, yes, we also provide the training.  One of the things that we feel very strongly about is if you have the opportunity, again, with the Fee-Per-Scan program to have the equipment put into your office with no financial commitments we want to make sure that you’re going to use it so we provide significant training to the physician and to the sonographer because we want them to truly understand the concept of an automatic acquisition versus the manual acquisition.  We want them to understand a quantifiable multi-planar display, and we want them to understand that they can step through that anatomy that’s required.  They can do it now or they can do it after the patient has left.  Using our machine, they scan the patient in the morning, step through their anatomy in the afternoon, and literally visualize a virtual patient.  We want the customer to really understand the true diagnostic capabilities of 3-D and to know that it’s more than just a baby face.  There are plenty of applications that you can use it for throughout the obstetric and gynecologic application as well as radiology.”

Roberta Speyer:  “Thank you for taking the time to talk to us, I know you’re very busy here at the RSNA meeting.  I also want to encourage all of our obstetrical and gynecological physicians when they’re thinking about acquiring new equipment to remember that Medison has been one of the staunchest and longest supporters of OBGYN.net.  When we were out there starting our educational juggernaut that we’ve now launched and is now the most well-known obstetric and gynecologic website in the world, not everyone stepped up to the plate.  It was a new technology and a new idea and Medison said - we’re there, we support this, and we’re going to help OBGYN.net be a success.  I think we should all remember that and when you’re looking to purchase new equipment, we should all make sure we get in touch with Medison, get Dennis out there, get one of these machines in your office, and see how it can enhance your practice.  Thank you, Dennis.”