EXPERIENCE AND

WITH

ULTRASONICS

IN GYNECOLOGY

OBSTETRICS N.

D. S e l e z n e v a

and

T. E.

Timofeeva

UDC 618.1/2-073.432.19

Ultrasonics is frequently of help in analyzing c o m p l i c a t e d o b s t e t r i c a l and gynecological pathologies. By an examination of pregnant w o m e n with ultrasound the p r e s e n t i n g p a r t and l i m b position of the fetus, the location of the placenta attachment, and the p r e s e n c e of h y d r a m n i o s and of a multiple p r e g n a n c y a r e d e t e r m i n e d m o r e a c c u r a t e l y . Gynecological t u m o r s having various s t r u c t u r e s give different types of e c h o g r a m s . This is of g r e a t p r a c t i c a l value b e c a u s e t h e r e is the p o s s i b i l i t y of c o n f i r m i n g o r r e j e c t i n g the existence of one kind o r another and also of m a k i n g a differential diagnosis between them. We p e r f o r m e d the f i r s t ultrasonic diagnostic examinations with a type UZD-4 i n s t r u m e n t which was developed by the All-Union S c i e n t i f i c - R e s e a r c h Institute of Medical I n s t r u m e n t s and Equipment in 1958. The type UZD-4 is a fixed, u n i v e r s a l diagnostic i n s t r u m e n t with which both o n e - d i m e n s i o n a l and twodimensional e c h o g r a m s can be obtained. The t w o - d i m e n s i o n a l e e h o g r a m s a r e achieved by a l i n e a r scanning m e t h o d using scanning ultrasonic t r a n s d u c e r s . The a p p a r a t u s can o p e r a t e at f r e q u e n c i e s of 0.88, 1.76, 2.64, and 5.28 MHz. The operating f r e q u e n c y used f o r the m o s t p a r t in o b s t e t r i c s and gynecology is 1.76 MHz.

In 1963 the s a m e institute developed the type UZD-5 ultrasonic diagnostic a p p a r a t u s f o r the s a m e p u r p o s e as the type UZD-4 but with g r e a t e r diagnostic potentialities. In this a p p a r a t u s the display has a l a r g e s c r e e n that p r o v i d e s an image of n a t u r a l s i z e , t h e r e is an automatic gain control s y s t e m , and the scanning t r a n s d u c e r s a r e m o r e portable. The type UZD-5 and the s i m i l a r type UDA-724 a p p a r a t u s e s a r e utilized not only f o r examinations in o b s t e t r i c s and gynecology but also f o r t h e r a p y , s u r g e r y , and o t h e r fields of m e d i c i n e . In 1969 at the All-Union S c i e n t i f i c - R e s e a r c h Institute of M e d i c a l - I n s t r u m e n t Design (AUSRIMID) the O b z o r - 1 0 0 ultrasonic diagnostic a p p a r a t u s was developed, the f i r s t d o m e s t i c a p p a r a t u s with c o m p l e x s c a n ning. The radiating p i e z o e l e c t r i c unit in its scanning t r a n s d u c e r p e r f o r m s two m o t i o n s simultaneously: a rocking motion on a c i r c u l a r a r c and t r a n s l a t i o n along the s u r f a c e of the body. As is well known, such a r a d i a t o r motion, which combines angular and t r a n s l a t o r y m o v e m e n t s , m a k e s it possible to i n c r e a s e the amount of information obtained. The Obzor-100 a p p a r a t u s underwent lengthy testing at the All-Union S c i e n t i f i c - R e s e a r c h Institute of O b s t e t r i c s and Gynecology of the M i n i s t r y of Public Health of the USSR. Over 100 women at various stages of p r e g n a n c y and with v a r i o u s t u m o r s w e r e examined. It was found that it was possible to obtain with this a p p a r a t u s m o r e p e r f e c t e c h o g r a m s and, as a consequence, m o r e valuable information. It should be noted that the examination p r o c e d u r e was m o r e c o m p l i c a t e d with this a p p a r a t u s although the patients e a s i l y endured this. The long e x p e r i e n c e in the use of ultrasonic diagnostic scanning a p p a r a t u s e s having different kinds of scanning p e r m i t s s o m e conclusions to be drawn r e g a r d i n g t h e i r r e l a t i v e potentialities and usefulness f o r diagnoses in o b s t e t r i c s and gynecology.

All-Union S c i e n t i f i c - R e s e a r c h Institute of O b s t e t r i c s and Gynecology. All-Union S c i e n t i f i c - R e s e a r c h Institute of M e d i c a l - I n s t r u m e n t Design, Moscow. T r a n s l a t e d f r o m iVteditsinskaya Tekhnika, No. 2, pp. 4445, M a r c h - A p r i l , 1974. Original article s u b m i t t e d M a r c h 29, 1973. © 1974 Consultants Bureau, a division o[ Plenum Publishing Corporation, 227 West 17th Street, New York, N. Y. 10011. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without written permission o[ the publisher. 'A copy o[ this article is available from the publisher for $15.00.

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The s i m p l e scanning a p p a r a t u s e s p r o v e d to be r e l i a b l e in s e r v i c e and s i m p l e to manipulate. T h e i r t r a n s d u c e r s w e r e p o r t a b l e , and they have flexible connections to the a p p a r a t u s which m a k e s t h e m v e r y m o bile So that t h e i r position on a p a t i e n t ' s body can be e a s i l y and quickly changed in o r d e r to obtain the m o s t i n f o r m a t i v e i m a g e s . A virtue of these a p p a r a t u s e s is the c o m p a r a t i v e l y r a p i d motion of the scanning r a diator (the duration of one o p e r a t i n g cycle is between 0.5 and 1 sec). The p o s s i b i l i t y of a r a p i d change in the t r a n s d u c e r position p e r m i t s an examination to be c o m p l e t e d within 5 to 10 min. The t r a n s d u c e r a r r a n g e m e n t f o r the c o m p l e x scanning a p p a r a t u s is m u c h m o r e complicated. It m u s t be mounted on a s p e c i a l stand, t h e r e b y m a k i n g a flexible connection with the a p p a r a t u s i m p o s s i b l e so that a change of the t r a n s d u c e r position with r e s p e c t to a p a t i e n t ' s body b e c o m e s m o r e difficult and r e q u i r e s m o r e time. The p r o c e s s of obtaining the e c h o g r a m is itself l o n g e r with this a p p a r a t u s than with s i m p l e scanning. The e x a m i n a t i o n t i m e is i n c r e a s e d to 15 o r 20 m i n p e r patient. In addition, the c o m p l e x scanning a p p a r a t u s is c o n s i d e r a b l y m o r e expensive. On the o t h e r hand, a c o m p a r i s o n of the r e s u l t s showed that the quality of the e c h o g r a m s obtained on the c o m p l e x scanning a p p a r a t u s w a s , as a r u l e , b e t t e r than on the s i m p l e scanning a p p a r a t u s e s ; the outlines of o b j e c t s , e s p e c i a l l y those of c o m p l i c a t e d f o r m , w e r e m o r e c o m p l e t e and c l e a r e r , and s m a l l e r objects could be distinguished. On the b a s i s of what has been said it c a n be concluded that scanning a p p a r a t u s of beth types m u s t be developed in the future. In view of the fact that m a n y diagnostic p r o b l e m s o c c u r r i n g in o b s t e t r i c s and gynecology c a n be solved v e r y s a t i s f a c t o r i l y with s i m p l e scanning a p p a r a t u s , it is evident that f u r t h e r development is needed on l i n e a r scanning a p p a r a t u s which is r e l i a b l e and s i m p l e to use, is i m p l e m e n t e d at a m o d e r n technological level, and has a choice of o n e - d i m e n s i o n a l and t w o - d i m e n s i o n a l scanning t r a n s d u c e r s . This type of a p p a r a t u s is p r e s e n t l y under development at AUSRIMID. The l i n e a r scanning a p p a r a t u s will have c a t h o d e - r a y displays on which both o n e - and t w o - d i m e n s i o n a l e c h o g r a m s can be o b s e r v e d . It is p r o p o s e d to provide scanning t r a n s d u c e r s of both the e x t e r n a l and c a v i t y type, the l a t t e r f o r i n t r a e a v i t y e x a m i n a t i o n s , t o g e t h e r with a s y s t e m f o r m e a s u r i n g distances v e r y a c c u r a t e l y on the e c h o g r a m s .

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Experience with ultrasonics in gynecology and obstetrics.

EXPERIENCE AND WITH ULTRASONICS IN GYNECOLOGY OBSTETRICS N. D. S e l e z n e v a and T. E. Timofeeva UDC 618.1/2-073.432.19 Ultrasonics is f...
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