“The Evolution of Ultrasound in OBGYN” – with Dr. Ana Monteagudo

Dr. Ana Monteagudo, an expert in ultrasound, discusses how the technology has advanced and the many uses for ultrasound in obstetrics and gynecology. She and Dr. Fox review changes in ultrasound technology, from physicians needing to “have a good imagination” to interpret images to today’s 3D ultrasound.

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Nathan: Welcome to today’s episode of Healthful Woman, a podcast designed to explore topics in women’s health at all stages of life. I’m your host Dr. Nathan Fox, an OB/GYN and maternal fetal medicine specialist practicing in New York City. At Healthful Woman, I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. 


All right. We’re here with Dr. Ana Monteagudo who is one of my partners and friends at Carnegie Imaging for Women and Maternal Fetal Medicine Associates. Ana, welcome to Healthful Woman. I’m so glad we got you on the podcast. 


Ana: Thank you for inviting me, it’s such an honor to be able to speak with you. Thank you very much. 


Nathan: Excellent. And as we discussed just yesterday morning, I know podcasts are not like your biggest thing in the world, this is opening up something for you. And maybe after this, you’re gonna be like a huge podcast listener and searcher and you’re gonna be all over the podcast world. 


Ana: Yeah, you know, I think I’m a little old. I don’t know. And podcasts is something that came around after my prime time in my life. But I’m open to growth and, hopefully, this is going to be the beginning of a wonderful experience listening to all this wonderful podcast. 


Nathan: Excellent. Listen, you know, before I started doing this, I was also very new to podcasts. I started listening to a couple because some friends recommended, and only after I started listening to them, I said, “Oh, you know, let’s do it.” But I agree, it’s sort of new to me as well but it’s a pretty cool…as the kids say, “It’s an interesting space,” that’s a word that’s used now. You and I didn’t ever use that before ever, space was an actual thing. Right? Or outer space. 


Ana: Absolutely, absolutely so. 


Nathan: Excellent. So Ana is well known in our practice and you’re well known regionally and nationally and internationally as an expert in ultrasound for OB and gynecology. And we’re so happy that, you know, you work with us and we work together. It’s amazing for us, amazing for our patients. And I thought, for our listeners, it would be really cool to get from you just a perspective on where ultrasound was like when you started to where it is now to go over sort of the development and incorporation of ultrasound into OB/GYN because it’s now like all the time, everyone has ultrasound and OB/GYN. 


Ana: Absolutely. You know, I’m going to say that, when I first started, let’s say when I was a medical student and even a resident, ultrasound was very…really, in the beginning, the technology you kind of had to look at the screen and try to somehow have a good imagination to be able to see what your professors were telling you. They would say, “Oh, that’s the baby’s hand,” and you would say, “oh my god, that looks like nothing.” So that’s when I started. And the technology really, every year, started changing and changing. But I think the most dramatic change in the technology was when we entered the early 1990s. At that time, the big news thing was 3D ultrasound. Up to this point, all the imaging were done what they called 2D ultrasound, only 2 dimensions. So, once the 3D ultrasound came into view, it really changed. You know, a lot of us only know to be the ultrasound because we see those beautiful gorgeous baby faces but 3D ultrasound is more than just a baby face. So, I think, over the last 25-30 years that I’ve been doing ultrasound, things have changed tremendously. And the technology, as you know and everybody knows in the field, yearly, it changes. So this has really revolutionized the way we deal with women, especially the way that we are able to treat and examine both pregnant women and gynecological women, women who need an ultrasound to look at maybe their fibroids. So this is really life changing. 


You know, when I was a medical student, we all were using like a stethoscope to listen to the babies’ heartbeat through the maternal abdomen. Right now, if we wanna see what the heartbeat is, we just do an ultrasound. So the ultrasound now has become what the stethoscope was in the 1960s and 1970s. It’s an amazing technology and it really has helped so many women. And of course I’m addressing women because that’s the only kind of patients that I see but of course it has helped all people in general. 


Nathan: Right. So, totally right. And I think, you know, just from a technology standpoint, if people think of anything, think of your telephone. Right? It went from this rotary phone that sat on a desk to now you have an iPhone or something and your watch. And the technology between the two is almost night and day. You know, the same thing has happened, obviously, in many sectors of the world but certainly in ultrasound. And so, just so our listeners understand, who are you? Where are you from? How did you get into medicine? We’ll talk about how you got into ultrasound just so people understand sort of your background. 


Ana: Okay. Very, very good. I’ll tell you a little bit about myself. My family and I came to the United States in 1968. At that time, I was a 12-year-old girl in middle school. And I always really liked medicine. Growing up in Cuba, one of my relatives was a doctor and he used to have his practice at home. And when I would go visit him, the biggest thrill that I had was trying to sneak into his office to see how he was dealing with patients. So, medicine was something that, from the very beginning, I was very, very intrigued. Once I went through my medical school, you know, then of course I grew up in New York City, I went to City College, Albert Einstein in the Bronx. I got my residency there, I did my fellowship in maternal-fetal medicine at Columbia Presbyterian. And then, after that, I worked for about 10 years as an attendee at Columbia. Subsequently to that I moved on to NYU where I spent 18 years there. I held many academic positions, including I was the chairman at Bellevue Hospital. I also eventually became the director of the maternal-fetal medicine program, as well as doing internal-fetal medicine fellowship where you teach the young doctors who want to become maternal-fetal medicine. And I have to say that, being a director of maternal-fetal medicine, especially the fellowship, was something that I absolutely loved. 


Nathan: How did you decide to do obstetrics and gynecology, and then, subsequently, maternal-fetal medicine? What led you, you know, to women’s health as opposed to a different field? 


Ana: Well, that is a wonderful question. And I do have to say that, when I was in medical school, we of course all have to rotate through all the different specialties. And I have to say that the two specialties that really intrigued me and I enjoyed the most during my rotation was obstetrics and gynecology and radiology. So, when it was time for me to try to merge the two things that I really loved, I realized that, if I become a maternal-fetal medicine specialist, I’ll still be able to see patients, take care of patients, but I still will be able to do the imaging that I really love. So that is how I ended up doing maternal-fetal medicine because it gave me the opportunity to do the imaging that I really always enjoyed as a medical student and as a resident. 


Nathan: Yeah, that’s so interesting because that makes a lot of sense. Because, in maternal-fetal medicine, I mean a lot of us have different focuses in what we do but a main part of our training and our practice is imaging, it’s like radiology. It’s mostly ultrasound and it’s mostly of the fetus of the baby. For some of us, we also do gynecologic imaging. And so, you know, we spend our time either in some percentage behaving sort of like a radiologist and sort of like, you know, someone who’s in clinical care taking care of patients and managing them and, you know, helping them. And so, it is a nice hybrid and that you saw that in advance. When you were training for your fellowship, like at Columbia, where was ultrasound, you know, at that point in time in terms of its, I guess, advances? Was it something that you had a lot of training in or is it something that you had to subsequently hone and develop over the course of your career as the technology got better? 


Ana: I was very lucky that I was given the opportunity to work in the place. At the time, they were the only hospital who had a dedicated OB/GYN ultrasound unit within the department of, you know, OB/GYN. 


Also, one of the new members of the department who came to the department around the same time that I did was a doctor named Dr. Ilan Timor-Tritsch who had just come to the United States from Israel after having developed what we call transvaginal ultrasound probe. So, when I first started my fellowship, we were using the transvaginal probe in ways that it had never been used before. For example, we started looking at the placenta, so we were the first ones to make the diagnosis of placenta previa using transvaginal ultrasound because, up to that point, they used to do the imaging trans abdominally. And many times, they could not really get the clear relationship between the placenta and the cervix. So, by doing transvaginal ultrasound, we were able to clearly show the patients, as well as the clinicians that were taking care of the patient, where was the placenta. 


In addition, doing the transvaginal ultrasound gave us an opportunity to start looking at the fetus in ways that the fetus never had been seen before. When I was a fellow, I decided that I wanted to learn more about the fetal brain. And I tried to look at the fetal brain through the maternal abdomen and the pictures were kind of fuzzy, they were not clear. But once I decided to start using the transvaginal ultrasound to look at the fetal brain…and I do have to say that I was among the first persons in the world whoever used this technology to look at the brain of the fetus…the amount of information that we were able to see related to the anatomy of the brain, the development. Then we went on and started looking at the very early fetus, or baby, in the first trimester and we were able to see things that no one had ever seen before. We were able to see the fingers, the toes in the first trimester. 


So it was an unbelievable exciting time when I was a fellow. We were working like crazy, I was one of those people who essentially lived at the hospital. I got there at 7:00 a.m., I stayed every night till 11:00-12:00 because, once we finished seeing patients, that was the time to start writing papers, doing research. And the amount of information, the amount of new things that we were seeing was amazing and we wanted to be able to share this with our colleagues. So we ended up writing lots of papers, writing lots of books, also giving lectures…so it was an amazing time of growth and seeing things that no one had ever seen before. I was privileged to work at that time. 


Nathan: The limitations of ultrasound is sort of where the probe, that’s what we hold in our hand, is in relation to what you’re looking. So, the closer you can get the probe to the object you’re looking at, the clearer the image is gonna be. That’s just part of the technology of ultrasound. So what I was saying is, you know, traditionally, the way we would look at anything in the mother’s belly, in this case in pregnancy, the baby, you’d put the probe on her belly and look around. And for many women that’s fine. But for things that are very low down in her belly, like in the pelvis, it’s hard to see it from the probe because it’s far away. So, what Dr. Timor had developed in Israel, what Ilan developed in Israel, Ana was talking about the training, is a probe that was designed to go in vaginally. And so, the end of the probe was all the way up at the top of the vagina, which is also the very bottom of the pelvis. And so, you could get the probe within a couple of centimeters of the cervix, the edge of the placenta, where the bladder is, and then the baby’s head, which is normally down there. And so, you can get much, much more detailed images of the fetal brain. So that’s sort of the technical reason why that’s done. 


And so, I’m just curious, you know, because, you know, for those who don’t know, Ana and Ilan have published hundreds of articles related to ultrasound, have written books on ultrasound in general, the fetal brain, you guys speak nationally, internationally. How did you sort of feel about that idea of becoming an expert in the field? Right? So, when you’re training, you’re sort of you’re learning, you’re learning, you’re learning, and suddenly, you turn around and you’re the expert and you’re being asked to talk about it and to write about it and give your opinion about it and teach others about it. When did you really feel that transition from, “I’m sort of a student and I’m learning,” to, “oh my god, I’m suddenly the person who I need to know all this and people are asking me about it.”? 


Ana: Well, I still think I’m learning. I still feel that I’m the student and I have had the opportunity to learn a lot. Yes, I know a lot more than some of my other colleagues but I think one thing that we always need to realize is we need to continue to grow and develop. I don’t know exactly when was that transition that I realized that I knew a little bit more than my other colleagues, I think it’s a very gradual transition. And suddenly, one day people are calling you and they’re calling you an expert. So I really cannot tell you exactly when it changed for me being the student, trying to learn this technology and trying to apply this new technology of ultrasound to image, both the pelvis and the baby, to when I became an expert. It’s just a very slight very slow transition. And there was not even one particular moment that I can say, “This was the day.” For me, I still feel that I’m learning and growing. And the day that I stop learning and growing and enjoying what I do, I think it’s the day I need to retire. 


Nathan: Not yet. And one of the interesting things, you know, with ultrasound, as you said before, you and I focus on ultrasound related to pregnancy and women’s health and gynecology but obviously, as all this is going on, it’s also going on in other fields. You know, there’s people who are looking at ultrasounds at the, you know, adult heart, so, cardiologists. Or even the baby’s heart, pediatric cardiologists, and people doing it for blood vessels, vascular and all of these things. So, what kind of interaction and collaboration did you have during all this time with people of other specialties in terms of just ultrasound? 


Ana: Well, this is very, very interesting because, when I was at Columbia, before I came to NYU, I had a very close relationship with the pediatricians, especially the pediatricians that work in the NICU, which are called the neonatologists. And I became very interested in helping them image the brain of the neonates. So, I had a close relationship with the neonatologists, as well as with radiologists. So, we had radiologists that I worked with on a weekly basis. So, when they were around, I liked to follow them, shadow them, and see what they were doing, so how they looked at the liver…as you said, we can look at the liver, we can look at the gallbladder to look for gallstones. So, this is going back to the fact that, when I was a medical student, I really loved radiology. So this is something that I’ve been interested. 


In addition to that, the other thing that we have a passion, and I think it’s the subject of a different podcast, is MRI, which also plays a big role in the imaging of both the baby, the uterus, and people in general. So, you know, I have been very lucky to have close relationships with people in different specialties. They have done ultrasound related to their specialties and I have learned a lot from them. 


Nathan: Right. And I think that one of the interesting things about people who do ultrasound, again, regardless of what field you’re in, there’s several unique aspects to ultrasound as opposed to other imaging, let’s say, CT scan or MRI or X-ray. And one of the things is that the examination itself is live, meaning you are, as you move the probe, the images move. Right? In the CT scan and MRI you basically get the image, and then, you spend all the time on the computer manipulating it, you move it left, you move it right, you rotate it, you know, you do this, you do that. But in ultrasound, you can actually, at the time, take the probe and say, “All right, I wanna see the top of, you know, the head, the bottom of the head. I wanna turn the angle this way, I wanna do this, I wanna do that.” And so, you’re doing it live, number one. And number two, you can actually look at objects that move, so, the heart. Right? It’s so much different to watch a video of the heart than it is to take a picture of it. And so, we get to do both. When you’re doing ultrasound, you can see how the heart works in motion and you can also take still pictures to look at various structures. And I think that’s one of the nice unique features of ultrasound that’s so helpful with pregnancy because we have to look at parts of the baby that are both still and parts of the baby that move. And of course the fact that it’s safe, which is great. 


Ana: Right. That’s why we say they know through the ultrasound, we’re doing in real time, so we’re seeing actually the baby move. The other thing that you did not touch upon is let’s say that a patient comes in and she has specific pain, let’s say, near her belly button. We can actually take the probe, put it near the belly button, and see what is below that area that she’s having pain. Maybe she has a little fibroid there. So we can actually guide the probe to where the patient may be having symptoms, maybe pain. So, like you said, this is all in real time, we see movement, we can see how things change as the patients breathe or as blood flow goes through the vessels. We can see blood flow going through the vessels. So it’s a very interactive kind of field. 


And the good thing is, as you are doing the ultrasound, you also have an opportunity to show the patient, in this screen, what is going on. So it’s also a good way for patients who never really get to see this to understand a little bit more what’s going on, why are they having pain. Or maybe they’re not having pain, maybe they just wanna see what the baby looks like or just wanna see what their kidney looks like. So, everything is very helpful. All this is in real time, we can see how things change with breathing, with blood flow going. As a patient moves, we can see changes. So, as you said, it’s a very interactive technology. 


Nathan: Right. We’ve been mentioning 2D and 3D. Explain to us, what’s the difference between…like what does 2D and 3D mean? Like what is the difference between those two? 


Ana: Well, 2D is the classic ultrasound but everything is very flat. But in 3D ultrasound, we’re adding a third dimension. So we’re gonna have not only…we’re gonna…height, width, and depth. So we’re able to see things a little bit in three dimension. That really helps us exactly sometimes locate structures. For example, if we do a 3D ultrasound of the uterus on someone who has a fibroid, we are able to exactly see where is the fibroid in relationship to the front, the back, the bottom of the uterus. So it really helps us pinpoint pathology more accurately. Not sure if I… 


Nathan: Yeah, I mean it’s almost a difference between getting a photocopy of something versus getting a 3D print out of something. You know, one of them you’re basically seeing a picture of it but a 3D, you you’re, “Oh, that’s in the back left. That’s this size. That’s pushing this way,” and we can get those images. I think that’s number one, you get to sort of see the three dimensions, which is, you know, sometimes helpful for diagnosis and sometimes, you know, just cool to see the baby’s face as a 3D picture, as you said before. But the other thing which is interesting is, and this is something where it does become sort of like an MRI or a CT scan, if we obtain a 3D image, sort of the computer has…we call it a volume, think of it like a cube that’s filled with all the images in there. And we can use the computer to manipulate that if we wanna see a very specific angle or we can stretch it out or bend it. And so, we could take something like the uterus, which is normally shaped like a boomerang, it’s sort of bent, and we can take the image and manipulate it to sort of straighten it out to see what the uterus looks like flat. And we can make diagnoses that you can’t make on 2D imaging. And so, the technology allows us, after the images are obtained, to like move them around and do stuff with them to really figure out what’s going on. The exam is the same for the patient, she wouldn’t know the difference if she’s getting a 2D or a 3D ultrasound from her end. It feels the same, it looks the same, it’s just the technology that allows us to do so much more. 


Ana: Absolutely. You know, by adding the third dimension that we…you know, especially in ultrasound, what we call the coronal view. For example, women that have an IUD were able to really locate that IUD in the uterus. It’s very, very helpful in trying to locate structures correctly. I think that many people think of 3D ultrasound as pretty baby faces. But I think the ultrasound is more than that, it has changed, revolutionized the diagnosis, not only of…I keep on saying OB and GYN because for other organs you have other technologies that we can use more like MRI or CT. But since ultrasound are just sound waves that totally cause…they’re radiation-free, this is something that we can use a lot in the uterus to be able to see the baby. And by adding the 3D, we can manipulate, get endless sections from different parts. So it’s very safe and really adds a tremendous amount of information to the scans. 


Nathan: Right. I mean, in pregnancy, we use it all the time. And like you said, imaging that uses radiation, there is some risk in pregnancy, generally it’s the amount of radiation. So a single X-ray typically is very safe but it doesn’t show you that much. A CT scan could show you a lot but it’s more radiation. MRI, like you said, is very valuable and it works but it’s difficult because it’s hard to find MRI machines, it’s a complicated exam to undergo. The baby’s always moving, which makes it hard, the mom has to, you know, lie still for 45 minutes. It’s tiring, it’s expensive. So we do it from time to time. We don’t do it ourselves, we refer to people and do it from time to time. But ultrasound is safe and it’s pretty easy to undergo. And if a woman’s not feeling well, she can go and come back. And we can, you know, get pretty much any angle we want of both the mother and the baby in real time. And so, it’s used all the time in pregnancy. Most people who are pregnant know that they’re gonna have ultrasounds. And that’s the reason we do ultrasound. And I wanted you to focus however on gynecology because it’s also so commonly used in gynecology. And why is that? Why is ultrasound really the method of imaging that we use more often than anything else for gynecology? 


Ana: So, let me take you back to when I was a medical student and a resident. How did we assess what was going on in the women’s health? People do what they call a bimanual exam. I don’t know if a lot of women remember this is that the doctor takes one hand and it places it in the abdomen, and then, inserts a couple of digits in the vagina and they try to figure out what is the shape of the uterus, where are the ovaries. And they try to mentally create a picture of what’s going on in the pelvis. 


So, and sometimes it’s hard to see, for example, if somebody has had multiple surgeries, there could be a lot of scar tissue. And maybe what they are feeling is the scar tissue, not necessarily the organ. So, by doing the transvaginal sonography, as you explained so eloquently earlier, is we are able to take the special vaginal probe inserted in the vagina and put it so close to the uterus. As a matter of fact, a lot of physicians no longer they perform the bimanual exam because they don’t get that much information. That’s why a lot of physicians have in their office an ultrasound machine and they do the transvaginal ultrasound of the pelvis and they’re able to quickly see the uterus and able to clearly see the ovaries. They can detect if there’s any kind of ovarian cysts. So, by doing ultrasound, it really changes from an exam that you had to imagine what you were seeing to actually seeing the structures in the pelvis. So I think, in gynecology even more than in OB, ultrasound has been a game changer. 


Nathan: Right. It’s just what you can see on ultrasound is so superior to what you think you’re feeling on an exam. I mean you’ll be like, “Oh yeah, I feel the ovary,” like, “no, that wasn’t the ovary.” I mean it’s hard, you’re feeling things through, you know, multiple layers and you can’t always know what’s what. But the ultrasound’s almost always clear as day, you know, what’s the uterus, what’s the size, what is the inside, the outside, the ovaries, the blood flow, the lining. You really see everything. How did you get into gynecologic ultrasound doing…you know, because you’re a specialist for pregnancy, right? You’re doing pregnancy, maternal-fetal medicine. But over the time with your ultrasound, when did you sort of develop all those skills? What was that opportunity for you? How’d that come about? 


Ana: Well, it was very interesting. Let’s go back to my fellowship. In my fellowship, we had an OB/GYN ultrasound unit and it’s called OB/GYN. So, not only did we do the baby, but we also did the gynecology. And as a fellow, as an MFM fellow, when we were rotating through the ultrasound unit, we had the opportunity to work with doctors, MFM doctors, or radiology doctors, or MFMs who did gynecology. So I learned gynecological ultrasound side by side to my OB ultrasound. So, from the very beginning, I was training both. And I think that, for me, that was a big, big advantage. 


Nathan: Yeah. Was that unique at the time? Meaning did you know, when you went around the country or the world and spoke to people who were experts in gynecologic ultrasound, were most of them maternal-fetal medicine specialists or were most of them OB/GYNs? Or were most of them radiologists? When you started this. 


Ana: Yeah, most of them were radiologists. And I would have to say that gynecological ultrasound, up to maybe the last 5 years, has been in the domain of the radiologists. You know, if you look at all the textbooks, all the people were running textbooks or articles in gynecological ultrasound, most of them are radiologists. I think I was in that unique and an unusual position that I learned during my MFM fellowship gynecological ultrasound. That was something unique because most ultrasound units, at that time, were only doing OB and all the gynecological ultrasounds were done in the radiology department. So that was a unique experience that I had. 


Nathan: Yeah, that’s interesting. I mean, if you look at…and I’m not knocking the radiologist, they do great work, but it makes a lot of sense that you would want someone who has training in OB/GYN doing the ultrasound there. Because, you know, it’s not just about seeing the organs, it’s understanding why something is happening and you can use what you’re seeing to help make a diagnosis, help develop a treatment plan, and it’s all done sort of in one brain rather than in two brains. Right? One person doing the imaging, another person doing the managing. It’s almost like…you know, I guess a corollary would be, when you go and get an ultrasound of your heart, an echocardiogram, the person who sort of does it and looks at it and reads it and gives you recommendations is typically a cardiologist. Right? They know the heart. It’s not a radiologist. And so, I guess it’s just hard for certain fields to be able to, not only take care of the patients, but also know the imaging. But in our field, we do get training in this. And I found in my own practice it’s such an advantage to be able to do the ultrasound and have that background in OB/GYN to help people with why ever they’re there and to help come up with a plan. 


Ana: Absolutely. And I think this is the reason why most ultrasound units that, maybe 10 years ago, were exclusively doing obstetrical patients have added or are adding the gynecological component. Because most maternal-fetal medicines, like yourself and I, before we became a maternal-fetal person, we were a regular OB/GYN gynecologist. We did gynecology in our training. So we have the understanding. And it just makes total sense, as you say, for MFM doctors or obstetrician gynecologists to do also the imaging of the pelvis. And I think this is why, if you go around the country, nowadays most ultrasound units are doing both, OB and gynecology, because of the understanding. 


Also, as you probably know, at the beginning of the pregnancy, it’s almost like a gynecological ultrasound. So I think that we, as physicians who deal with very, very early pregnancy, we really have to understand a lot of the diseases in gynecology because, when we see somebody who’s extremely early in pregnant, it’s essentially almost like a gynecological exam. So I think it’s very helpful. And I really predict that, in a few years, everywhere radiologists will be doing the MRI and the CT scan and the ultrasound part of the study of women will be at the hands of the OB/GYNs and MFMs. 


Nathan: That’s interesting. And I was actually gonna ask you, it’s a good segue about, you know, in terms of where we’re headed. So, obviously, I assume technology will, hopefully, continue to improve and we’ll be able to see more. But just in terms of broader strokes, what you see the role of ultrasound? So that was one thing that you think that gynecologic ultrasound is gonna continue to grow amongst people who practice OB/GYN and maternal-fetal medicine and sort of image pregnancy. Are there any other, you know, future directions either you know are happening or you hope happen or you predict will happen based on your own experience and what you hear from talking to your colleagues around the world? 


Ana: I think the new thing in ultrasound is something that is already, to a very minor degree, is beginning to be integrated is artificial intelligence. I think ultrasound, the machine is gonna be able to help us make better diagnosis. You know, for example, the machine will be able to help us make differential diagnosis. At times, we see things that we have never seen before. And what did we use to do years ago? We had to run out of the room, maybe look at a textbook. But I think now, as artificial intelligence is going to be more and more prevalent, a lot of these ultrasound machines will be essentially like a computer that will be able to give us a little help, or a lot of help, in trying to make difficult diagnoses. So I think the next breakthrough is artificial intelligence, not only to help us make differential diagnoses, but also, for example, to make the job of the sonographer, which are the people who actually do the ultrasound…we have sonographers and sonologists, the doctors who are called sonologists. And in the old days, we used to call them technicians, they are the sonographers. 


So, for example, a new thing that a lot of the companies are doing is to do measurements of the different parts. For example, when we have a pregnancy, a baby, we measure many different parts of the baby. We measure the head, we measure most of the bones. And it’s very time consuming to be able to get the exact view and the exact measurements. And with the new technology that people are working on, this is going to be facilitated. Once you tell the machine that, “I want to measure the baby’s legs,” once the ultrasound machine recognizes that you have the right view, they will tell you, “this is the right view,” and they may even do the measurements themselves. So I think artificial intelligence is the next thing. 


And I think it’s a little bit beginning to appear. For example, as you very well know, one of the most difficult organs to understand, when you’re scanning the fetus, is the heart. It’s very difficult to be able to get [inaudible 00:36:57]. It’s because the baby is constantly moving and the different structures of the heart, where they are, it not only depends if the baby is, what they call, in breech presentation with their bottoms down, with their head…so, a lot of the new machines, you can take a volume, as you said earlier, and you tell the machine, “This baby’s head was lower. The spine of the baby was on the left,” and automatically, they’ll be able to generate some of the pictures that we want of the heart and help us. So I think artificial intelligence is gonna change how we do our job. It’s gonna make us much better by looking at the baby with ultrasound. 


Nathan: Listen, it’s important. Because, as my intelligence continues to drop, we need something to fill in the gap. So, if the machines can bring it into the room, that’d be awesome. We can try to stay at a steady state over time. That’s amazing. Well, Ana, this was great. Thank you so much for coming to talk about, you know, ultrasound and the evolution of ultrasound and your experience. And, you know, for women out there, either, you know, pregnant, non-pregnant, it’s very likely that, at some point, you have or will undergo an ultrasound. And again, this technology is really good. It’s safe. We’re learning more and more, we’re seeing more and more. And the ultimate goal is really just, again, to help women, you know, pregnant or not, in terms of what’s going on, you know, because of people like you who have been studying this and learning this for a long time now. So, thank you. 


Ana: Well, thank you. It was a pleasure being able to share with you this podcast and to tell you a little bit about ultrasound. I’m very passionate about ultrasound, as you hopefully heard on my delivery. 


Nathan: Yeah, and then, what’s gonna happen, once this podcast drops, you know, flying a team from Vienna, we’re gonna set you up so you can listen to the podcast and, you know, get it all loaded on your phone. And then, you’re gonna be hooked and you’re never gonna show up to work anymore, you’re just gonna be walking around town listening to podcasts. Excellent. 


Ana: Sounds like a deal. 


Nathan: All right, Ana, thank you so much. 


Ana: Okay. Have a good evening. Bye-bye. 


Nathan: Thank you for listening to the Healthful Woman podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s H-E-A-L-T-H-F-U-L-W-O-M-A-N .com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. 


The information discussed in Healthful Woman is intended for educational uses only and does not replace medical care from your physician. Healthful Woman is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.