New Advances with 3D Ultrasound

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Dr. Strahimir Banovic: “I’m Dr. Banovic for OBGYN.net and we have the pleasure to have here with us at the Conference from Australia Dr. George Kossoff.  I’m taking the opportunity to ask him how he feels about his stay in Zagreb and how he feels about these other Congress issues attending now please.”

Dr.George Kossoff:  “Zagreb to me is a friendly city, I’ve been here on a number of occasions and it’s always impressive to see how it continues to expand.  There are certain things at the conference, the friendliness of the people, and the other thing that I really enjoy in coming to Zagreb is to see the work being performed by the group being headed by Professor Kurjak.  I think they’re pioneering many applications and I continue to be impressed by the quality of the work.  They show tremendous imagination, clinical skills, and interpretation of the results that are obtained so for me it’s always a very interesting learning experience.”

Dr. Strahimir Banovic:  “Apart from that, what do you think about the ultrasound which we are seeing now, and what do you think about advances which you’ve seen so far from the last year?”

Dr. George Kossoff: “Three-dimensional ultrasound to me is undoubtedly one of the frontiers of ultrasound but it’s still very much in, shall we say, the development stage whereby we’re learning what this modality is capable of providing us with. There are to me differences between, shall we say, areas of research and I think this is where the major contributions are currently coming from. Here is where clinical acceptance is still being developed, and I think we’re seeing some results that are being put forward in some cases of studies of infertility which I think for the first time over here have to me looked like they’re being ready to be applied in the clinical arena but I’ll wait to sort of see how it will be applied because it’s always one thing to see the results being developed by hands of experts and then to see whether the same results can be obtained in a general community.”

Dr. Josh Copel:  “Now with infertility you’re talking of the use of 3-D ultrasound when they’re inflating tubes with contrast material, I think we saw some of that last night. We also saw in Professor Campbell’s lecture last night the new transducers that will have electronic two-dimensional arrays of crystals that will be fired sequentially, hopefully, to provide real-time 3-D images. How close are we to seeing that actually coming into our hands as clinicians?”

Dr. George Kossoff:  “I think 2-D transducers are certainly in the research arena now.  How close they are to being provided into clinical hands, I’m really not in a position to answer that.I think the main advantages of those 2-D arrays is the fact that we’ll be able to obtain the information in real-time. I think the technologies are currently existing to provide information in what I would call 4-D real-time and if things aren’t moving too rapidly, of course, real-time is not too bad in providing information in many applications. So I think we’ll be seeing advances in clinical practice with some of these causing real-time things that will then indicate to us how much more we can be prepared and sort of obtain once we do really obtain this information in genuine real-time.”

Dr. Josh Copel:  “A few years ago, I think it was in Budapest at this same meeting, you presented a new lens to fit on the ultrasound transducer.  Did that provide the same kind of 3-D?  I’m trying to remember the presentation because I haven’t heard more about it.  Did that not measure up to the other advances in 3-D that are internalized in the ultrasound equipment itself?”

Dr. George Kossoff:  “That was actually a very interesting technique in the sense of the fact that it provided us 3-D information for a cost of $3 because all you had to do was put a diversional plastic lens on a transducer to get those 3-D images. I think the images in patients who have had a generous amount of liquor were, in fact, very spectacular and even I would say today those images are superior to what is being produced by the more, shall we say, sophisticated equipment. My disappointment with this technology was the fact that our clinicians, although are being impressed by the quality of the images, didn’t really think that the extra time required to obtain those images justified their effort, because everything today is sort of so much based on cost effectiveness and to be able to obtain a pretty look at a baby’s face itself was not really cost effective because we do not encourage video screening of normal fetuses, shall we say. It really was not taken up by the physicians even though the images were very attractive so that’s where we stand now.”

Dr. Josh Copel:  “If you have any of those lenses left, you can send them to us in New Haven, we’d like to play with them still.  Jack, do you have another question.”

Dr. Strahimir Banovic: “Yes, Dr. Kossoff, I had a chance in 1975 to join Stuart Campbell in introducing medical ultrasound in London.  Tell me, what do you think about 4-D as a final question?”

Dr. George Kossoff:  “I presume by 4-D you really mean 3-D in real-time.”

Dr. Strahimir Banovic: “That’s right.”

Dr. George Kossoff:  “I guess that was the question that Josh was asking me just previously. I think those two-dimensional arrays will provide us with real-time capability. I guess you are aware of the fact that such equipment can in fact be purchased. A team from the United States at Duke has a company that manufactures such equipment that is used primarily to study the adult heart and some results from the study of the fetal heart were being demonstrated at this meeting. I think the results were most exciting and I look forward to sort of seeing how they will be applied clinically.”

Dr. Josh Copel:  “Thank you very much.”