Obstetrician Ian Donald was the first to use ultrasound for the detection of fetal inconsistencies. The technique would become a valuable tool in medicine and obstetric health.

In the early 1900’s, two major events made it essential to develop an appropriate means for detecting unseen underwater objects. First, the Titanic disaster in 1912 involved a large submerged, unseen, and silent iceberg. This obstructive and destructive iceberg caused the sinking of the Titanic and resulted in the loss of many lives and of valuable treasure. The second event was the threat to the Allied powers by German U-boats during World War I. The threat of possible defeat at sea was sufficient impetus for the French and English Admiralties to form a joint committee in 1917. The Anti-Submarine Detection and Investigation Committee Anti-Submarine Detection and Investigation Committee[Antisubmarine Detection and Investigation Committee] (ASDIC) found ways to counter the German naval developments. Paul Langevin, a former colleague of Pierre Curie and Marie Curie, applied techniques developed in their laboratories in 1880 to formulate a crude ultrasonic system to detect submarines. These techniques used beams of sound waves of very high frequency, which were nondivergent and under directional control. Ultrasound
Obstetrics
Diagnostic technologies
[kw]Donald Uses Ultrasound to Examine Human Fetuses (1958)
[kw]Ultrasound to Examine Human Fetuses, Donald Uses (1958)
[kw]Human Fetuses, Donald Uses Ultrasound to Examine (1958)
[kw]Fetuses, Donald Uses Ultrasound to Examine Human (1958)
Ultrasound
Obstetrics
Diagnostic technologies
[g]Europe;1958: Donald Uses Ultrasound to Examine Human Fetuses[05720]
[g]United Kingdom;1958: Donald Uses Ultrasound to Examine Human Fetuses[05720]
[c]Health and medicine;1958: Donald Uses Ultrasound to Examine Human Fetuses[05720]
[c]Science and technology;1958: Donald Uses Ultrasound to Examine Human Fetuses[05720]
Donald, Ian
Langevin, Paul
Stewart, Alice

A technician helps a women view her fetus through ultrasound.

(Digital Stock)

The advent of World War II made it necessary for the development of faster electronic detection technology to improve the efforts of ultrasound researchers. Langevin’s crude invention evolved into the sophisticated system termed sound navigation ranging (sonar), Sonar which was important in the success of the Allied forces. Sonar was based on the pulse echo principles and, like the radio detecting and ranging (radar) system, had military implications. This vital technology was classified as a military secret and kept hidden until after the war. Later, it was applied to engineering, metallurgy, and other industrial uses. At the same time, in medicine, concerns were being raised over the use of ion-producing X rays on pregnant women.

Ian Donald’s interest in engineering and principles of sound waves began when he was a young schoolboy. While he was in the British Royal Air Force, he continued and maintained his enthusiasm by observing the development of the anti-U-boat warfare efforts. He went to medical school after World War II and began a career in obstetrics. By the early 1950’s, Donald had embarked on a study of how to apply sonar technology in medicine. He moved to Glasgow, Scotland, a major engineering center in Europe that presented a fertile environment for collaboration and interdisciplinary research.

Donald collaborated with engineers and technicians in his medical ultrasound research. They used inanimate and tissue materials in many trials. Donald was applying his ideas in clinical research to develop applicable and appropriate ultrasound technology in medicine, especially in gynecology, his specialty. Several of his early research efforts were destroyed by powerful generators, excessive heating of tissue, and other inappropriate experimental methodologies. His failures led to new pathways and new discoveries. He was interested in adapting the A-scan method of probing metal structures and welds for cracks and flaws to medicine.

Kelvin Hughes Hughes, Kelvin , the engineering manufacturing company that produced the Flaw Detector Apparatus, gave advice, expertise, and equipment to Donald and his associates to continue their research. Based on the applicability of this equipment, Donald devised water tanks with flexible latex bottoms. These were coated with a film of grease and probed onto protuberant abdomens of women. In 1957, an unusual case made Donald realize the potential of ultrasonic use in medicine. A male patient with a large atrial mass, clinically diagnosed as a myxoma, needed a mitral valve repair. Donald made the correct diagnosis with his ultrasound equipment prior to surgery. The echo picture enabled him to determine that a dislodged thrombus produced the atrial mass, not a myxoma. The patient died before surgical intervention, but the autopsy confirmed the diagnosis.

The use of diagnostic radiography X rays;medical applications became controversial when it was evident that these examinations were the cause of potential leukemias and other injury to the fetus. It was realized from the earliest days of radiology that radiation may cause tumors, particularly of the skin. The aftereffects of radiological studies in obstetrics were recognized much later and confirmed by studies of atomic bomb survivors and of patients receiving therapeutic irradiation. The use of radiation in obstetrics posed several major threats to the developing fetus, most notably the production of neoplasm later in life, genetic damage, and the production of development anomalies in the unborn fetus.

In 1958, bolstered by earlier clinical reports and animal research findings, Alice Stewart and her colleagues presented a major case control study of 1,326 children in England and Wales who had died of cancer Cancer;and X rays[X rays] before the age of ten between 1953 and 1958. There was a 91 percent increase in leukemias in children who were exposed to intrauterine radiation, as well as a higher percentage of fetal death. Although controversial, this report led to reduction in the amount of exposure of pregnant women to X rays, with subsequent reduction in fetal abnormalities and death. These reports came out at a very opportune time for Donald to accomplish the development of a technique: ultrasonography that would provide useful perinatal information without the adverse effects of radiation. These findings gave impetus and credence to the use of ultrasonography in obstetrics.

The use of ultrasound gained ground. Obstetricians were able to visualize echoes from fetal heads, and this mechanism helped them in determining difficult cases before delivery. Donald was also able to measure accurately the biparietal diameter. The technology continued to improve from the limited unidimensional A-scan technique to the plan position indication (PPI) system, a two-dimensional system developed during the war. This PPI system produced a series of dots of light that coalesced to provide tissue outlines. This improvement led to the easier visualizations of the X and Y linear potentiometers and the determination of inclination by sine/cosine potentiometers. This resulted in the B-mode ultrasound technique that is used widely today.

During a meeting of the American College of Surgeons, held in Glasgow in 1958, Donald presented case reports of his work to demonstrate the results of their years of efforts in the application of ultrasound in obstetrics. They could differentiate with certainty several gynecological tumors, ascites, and gross obesity. Unfortunately, fetal echoes, especially the cranium, were demonstrable only when they were above the level of the pubis symphysis. Donald’s research report on his work with ultrasound was published in 1958 with the renowned English medical journal, Lancet. This technology was still in its infancy, and it had many potentials. To eliminate the flaws, the Kelvin Hughes Center developed an automatic scanner for standardization. These developments are still in use today.

Ultrasound utilizes high-frequency sound waves produced by small pulse generators. These pulses usually range from 1 to 10 megahertz. A crystal that transmits the sound beam also can be used to receive the reflected signal. The signal (sound wave) varies, depending on the tissue density. The reflected sound is displayed on a scanning oscilloscope.

In medicine, low-power ultrasound is used in place of radiation-producing X rays to reproduce images of internal bodily organs. In one method, the A-mode measures tissues, which is then converted to distance. This is used in echoencephalography to measure midline deviation in procedures where needle aspiration is required.

A second method is B-mode scanning, which indicates enhanced brightness. The returning echoes are displayed as dots of varying brightness on a phosphorus-coated oscilloscope, with Polaroid photography making a permanent record. The B-mode scan is widely used because of its versatility. It can be applied in the scanning of the neck, abdomen, pelvis, and extremities. In combination with Gray-scale scanning, the B-mode technique is able to display internal structures of varying density as procedures are performed. It makes the identification of the correct fetal head diameter to be measured (the biparietal diameter) much easier. Another method is the TM-mode, which is used primarily in echocardiography. The pulsating heart requires a fast technique that will permit the sound to enter the chest and return before the next sound pulse.

With continued refinement and development, ultrasonography is now a highly specialized and technical field. Today, every area of medicine is affected by the use of ultrasound in some way. The usefulness of ultrasound in obstetrics is a result of its ability to visualize anatomical detail, detect time-dependent changes in structural organization, and characterize the three-dimensional geometry of intrauterine structures.

Diagnostic ultrasound first gained clinical acceptance in obstetrics, and its major contributions have been in the assessment of fetal size and growth. The use of ultrasound in obstetrics goes beyond diagnostic enhancement. In combination with amniocentesis, ultrasound is an invaluable tool in operative procedures necessary to improve the outcomes of pregnancy. Other uses in pregnancy include detecting multiple gestational sacs, diagnosing missed abortions, identifying blighted ova, diagnosing ectopic pregnancy, locating the placenta prior to amniocentesis, predicting fetal maturity and development, displaying retained products of conception, and detecting fibromyoma during pregnancy.

As can be expected, safety has been a concern especially for a developing vulnerable fetus that is exposed to high-frequency sound. The hazards are well documented in medical literature. It is understandable that some fear may be applicable to radiation-producing X rays in the use of sonar in obstetrics. Research has not been able to document any known ionizing effect of sonography on the developing fetus. It produces neither heat nor cold. It has no cantation effect. It has not been shown to produce any toxic or destructive effect on the auditory or balancing organs of the developing fetus. Teratogenesis and interference with normal development have not been evident in extensive research performed. Chromosomal abnormalities have not been reported in any of the studies conducted.

Ultrasonography, because it is safe and noninvasive, has become the principal means for obtaining morphological information about intrauterine structures. With this procedure, the contents of the uterus—as well as the internal structure of the placenta, fetus, and fetal organs—can be evaluated at any time during pregnancy. The use of ultrasonography remains a most valued tool in medicine, especially obstetrics, because of Donald’s work. Ultrasound
Obstetrics
Diagnostic technologies

• Bartrum, Royal J., Jr., and Harte C. Crow. Real-Time Ultrasound: A Manual for Physicians and Technical Personnel. 2d ed. Philadelphia: W. B. Saunders, 1983. This is a how-to technical book that informs physicians and ultrasonographers of the applications of this medium in the diagnosis of various illnesses.
• Callen, Peter W., ed. Ultrasonography in Obstetrics and Gynecology. 4th ed. Philadelphia: Saunders, 2000. Discusses the various aspects and applications of ultrasound in obstetrics and gynecology. Contributors include radiologists, obstetricians, gynecologists, anatomists, surgeons, and perinatologists. Excellent source for the interested reader.
• Donald, Ian. “Medical Sonar: The First Twenty-five Years.” In Recent Advances in Ultrasound Diagnosis 2, edited by Asim Kurjak. New York: Elsevier North-Holland, 1980. Donald writes about his search and development of the ultrasound uses in medicine.
• _______. “Ultrasonics in Obstetrics (Sonar).” In Practical Obstetric Problems. 5th ed. London: Lloyd-Luke, 1979. Discusses the practical application of issues and problems that occur in obstetrics. The discussion on ultrasound is found in the last chapter. Covers the future of this diagnostic modality.
• Stewart, A., J. Webb, and D. Hewitt. “A Survey of Childhood Malignancies.” British Medical Journal 10 (1958): 1495-1508. For the interested reader.

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