3-D ultrasound more than just a pretty baby face

Although Dr. Barry Goldberg opened the American Institute of Ultrasound in Medicine’s San Francisco convention this month with a lecture and slide show tracing the history of ultrasound over the last half century, this show was about the future.

As Goldberg talked about how gray scale and multiplane imaging brought ultrasound much more detail than doctors ever thought possible, exhibitors down the hall pushed the next frontier—three-dimensional ultrasound. Nearly 80 exhibitors and about 2500 participants attended the meeting.

Ads of diapered babies wearing red and green 3-D glasses lined the exhibit walls, and some company officials claimed gallstones would “jump right off the screen” using their 3-D ultrasound system technologies. Market research firm Frost & Sullivan estimates the 3-D ultrasound market will reach $700 million by 2003.

Even companies that aren’t pushing 3-D right now are preparing to. Biosound Esaote’s Technos ultrasound model will have the capacity to image 3-D, possibly by next year, company officials said.

The 13 medical equipment vendors touting 3-D at AIUM said their ultrasound systems were patient-friendly, fast, and capable of imaging the volume and depth of human anatomy so that clinicians could cull vital data and make more accurate diagnostic decisions.

However, like many technological innovations in medicine, 3-D ultrasound has been described as an advance that has the chance of racing ahead of clinical capabilities. Radiologists in Asia and Europe are much more comfortable with 3-D ultrasound than U.S. doctors, and recording real-time information data is tricky (Diagnostic Imaging 3-D Ultrasound, 3/00).

ATL Ultrasound, a division of Philips, advertised its 3DI Work ultrasound system. Features of the system let clinicians look at 3-D and 2-D images of the same organ next to each other on the same screen. Clinicians can collect and render images offline so they don’t tie up a machine that another clinician may want to use for a live scan.

Toshiba Medical Systems displayed its PowerVision 6000 and 8000 models. These models use software that let radiologists or technologists place 3-D and 2-D images of the same organ in gray-scale or color-angio modes. In addition, the operator can click back and forth between the two options with a button. The 3-D also visualizes blood flow in and out of tissue, structures, and masses, said Scott Yarde, Toshiba’s marketing manager for ultrasound.

This is the first year Hitachi unveiled ultrasound systems with 3-D capabilities. Its 525 system can handle a system upgrade with 3-D, while its new 6000 series has 3-D built into it.

Three-D capability or no, an effective ultrasound must have top-notch Doppler, color, and imaging capabilities to work well for the physician, said Omar Ishrak, GE Medical Systems’ vice president and general manager of ultrasound.

“Three-D may become the bread and butter of ultrasound, but today it’s not,” he said.

In addition, 3-D is found mostly on high-end machines and is effective in only 50% to 70% of cases, Ishrak said.

“Many clinics prefer low-end machines because of cost,” he said.

GE showed off its Logic 400 and 700 ultrasound models. Three-D capability was installed three years ago in the Logic 700. Last year, the system’s 3-D capabilities were improved. Ultrasound pictures on display at GE’s booth illustrating a 3-D surface rendering of a fetus at nine weeks were much clearer than those available when the capability was first installed on the same model.

Ishrak seemed most excited about the unit’s ability to track blood perfusion with color B-Flow imaging as a stroke-prevention method and its harmonic imaging that visualizes breast cysts.

Despite clinical challenges that surround 3-D, it is a popular modality this year, said Heike Seck, Siemens’ product manager.

“A lot of companies are using 3-D as a promotion,” he said.

This year’s hardware and software upgrades to Sonoline Elegra, the company’s flagship ultrasound system run by a supercomputer, have made clinical inroads by displaying the walls of blood vessels in 3-D, Seck said.

Company officials say they feel the pressure to give patients something concrete to see.

“Most of the market wants 3-D,” said Shai Saar, Biomedicom sales manager. “They want image.”

Biomedicom codeveloped BabyFace with Sonora Medical Systems, a company that sells used and refurbished medical imaging systems. The 3-D surface-rendering tool is a system upgrade using high-speed 3-D imaging to transform the flat, frontal view of a fetus into a doll-like image. New York based-Misonix, which has a 51% stake in Sonora, received 510(k) clearance for the tool from the Food and Drug Administration for BabyFace last month.

Saar claims the transition to 3-D requires little change in clinician training. A system accustomed to acquiring flat images can go 3-D with the push of a button, he said.

“We tell clinicians they can work with 3-D the same way they work with 2-D. We tell them we won’t change their working habits,” Saar said.

An easy transition to 3-D imaging is especially important with the current dearth of sonographers, said Michael J. Kammermeier, a Medison clinical specialist.

Crystals in a stable, handheld transducer on Medison’s Voluson 530D ultrasound sweep areas of interest, and images are displayed in multiplane views.

“People think 3-D is this pretty, spinning baby face on the screen,” said Dennis Wisher, Medison’s director of education and clinical development. “It’s a lot more than that.”

Medison’s 3-D ultrasound has greater clinical capabilities than competing systems because it images tumors and cysts in a way that allows measurement of volume and depth, Wisher said.

Because of the demand in 3-D ultrasound, Medison has packed up its Pleasanton, CA, headquarters and moved to a facility twice the size in Cypress, CA. In addition, the company has hired a dozen more people.

“We expect a very big year,” Wisher said.