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Filly is chief of diagnostic ultrasound and a professor of radiology, ob/gyn, and reproductive science at the University of California, San Francisco.

DI: How does new technology move from clinical research into clinical practice?

Filly: It depends on the type of research. Clinical research will be published in a journal or presented in a lecture, which is the single biggest mechanism by which a new technique gets into practice.

Research needs to have an advocate, not just the stilted, formal scientific paper that turns off the average practitioner. You need an evangelistic approach to really get clinical users fired up.

The danger with clinical research is that an individual can understand a study poorly and apply it inappropriately and end up misinforming a patient in the process. You can scare a lot of pregnant women that way.

As far as research on technical or instrumentation issues, generally something can't find its way into practice until a medical instrumentation company adopts it and takes it through the many steps of development and approvals.

The good news is, if it works, you'll see it at demonstrations and meetings and moving into the next iteration of equipment. Biochemical products, such as new contrast agents, of course require the long road through manufacturing and the FDA.

DI: So this is the process that contrast agents, three-dimensional, and other advanced technologies are going through?

Filly: The hurdles for 3-D are the same as for any other technology when it comes to clinical practice: Is it possible? If so, it this a valuable use of the clinician's time? If they are going to spend precious time to do it, is it reimbursable? Is it practical for the patient? All these questions are part of the decision-making process that goes on daily in an ultrasound practice.

Contrast agents-here's something that has been really prominent in the literature for five or six years and looks really good, but it turned out to be not as great as we initially thought, not because they didn't work but because of issues of practicality. It turned out to be expensive and nonreimbursed, except for a few cardiology applications, so there's little impetus to move forward.

Now we're making instrumentation changes that may make contrast agents more attractive in daily use. Even if the clinical literature is unambiguous, until it's reimbursable, no one can use a contrast agent under the constraints of modern healthcare management.

DI: Which emerging technology excites you the most?

Filly: I believe ultrasound contrast agents, with proper instrumentation and harmonics, are one of the biggest things to hit ultrasound since real-time imaging. There are so many steps that need to occur before it can be used routinely, however. Things that look promising today may not happen for five or six years.

DI: What helps the most in moving technology forward?

Filly: Aside from reimbursement, it's an evangelist who says, "Look what I can do, and wouldn't you like to do it too?" and gets people excited when they see the technology at a conference. You can't just have something in the ultrasound literature: It's too formal a mechanism to really push new technology. And then, of course, the technology has to turn out to work the way we think it will. Contrast agents could be derailed by patients having reactions to them.

After 30 years of observing the field, I've never seen a time when there was more happening in technology and biochemicals, and more clever notions about how to approach things. It's an absolutely great time for ultrasound, and I see the field moving forward on many fronts.