A short history of the development of Obstetrical and Gynecological ultrasonography in France

The basis of ultrasonic operations, the piezo-electric effect was discovered by Pierre Curie and his brother Jacques Curie in Paris, France in 1880. Another eminent French scientist, Paul Langévin was reponsible for inventing and developing powerful high frequency ultrasonic echo-sounding devices (the hydrophone) in the 1910s. Langevin's hydrophones had formed the basis of the development of naval pulse-echo sonar in the following years. Other French scientists in the study of ultrasonics, namely E Biancani, André Dognon and André Dénier at the research center in Salpêtrière in Paris also embarked on ultrasound insonation experiments before the 1950s. Denier published his theoretically work on ultrasonic imaging in 1946, among other works on ultrasound used in therapy, and suggested the possibiity of "Ultrasonoscopie". This was a transmission technique and recordings made on a micro-ampere meter and oscilloscope. Although equipments were fabicated no definite images were published. In 1951, he published the book "Les ultrasons appliqués a la médecine" (the application of ultrasound in medicine). A-mode ultrasound scanners evolving from metal flaw detectors were starting to appear in the early 1950s, but these were produced mainly in neighboring countries such as Britain, Austria and Germany.

Largely as the result of the proximity of Germany, where the development of ultrasonics and A-mode scanners had taken a lead, ultrasonography in Obstetrics and Gynecology began in Eastern France, namely, in Strasbourg and Besançon.

Work in diagnostic ultrasound first started in Neurology and Ophthalmology in the early 1960s. Therèse Planiol, in Tours, first evaluated cerebral echography in 1963, using an A-mode instrument from the French manufacturer Alvar. Jacques Poujol started echography of the eyes in 1964. Cardiological investigations were also strted with pioneers Léandre Pourcelot, D Kalmanson, Jaques Pernod and C Veyrat.

As a resident in Obstetrics and Gynecology, Georges Boog had been charged with the duty by his chief, Professor Gandar to introduce obstetrical sonography at Strasbourg University in the Spring of 1967. Initially Boog worked with an A-mode scanner from KretzTechnik®, Austria devoted to metal flaw detection and was able to realize the first fetal cephaIometries from the typical three peaks pattern. He also tried to localize the placenta following the strong reflection at the interface between the placenta and amnniotic fluid. Two years later, after acquiring a new B-mode compound contact scanner from KretzTechnik®, he published the first French paper on the clinical applications of fetal cephalometry, sonographic placentography, detection of molar pregnancies and differential diagnosis of cystic and solid pelvic tumors. At the First World Congress on Ultrasonic Diagnosis in Medicine, Vienna, Austria in 1969, Boog presented the paper "Ultrasonic Cephalometry in the diagnosis of chronic placental insufficiency" (in French). Other works in Obsetrics and Gynecology came from C Colette in Besançon. They promeoted their methods in Paris and greatly contributed to the development of ultrasonography in the specialty.

During the year 1970, Francis Weill, working at Besançon, presented a comparison between thermographic and tomoechoscopic localization of the placenta. He was also a fervent usuer of the Vidoson fast scanner from Siemens. In 1971, he organized the first multi-disciplinary meeting on Ultrasonography and gained much international recognition.

In the same year, Professor Therèse Planiol and Léandre Pourcelot in Tours and Professor Jean-Marie Thoulon in Lyon initiated Doppler ultrasonography in obstetrics. Pourcelot developed the first European ultrasonic Doppler velocimeter in 1964. In 1974 he described the "Resistance Index" or the "Pourcelot index" used in the assessment of doppler velocity waveforms. In 1977 he described pioneering work on color-coded Doppler images. For the past 40 years he has continously worked at inventing and perfecting doppler devices at Tours. In the late 1960s the Jean Perilhou group at Bourg La Rhiene conducted pioneer research into the multi-element scanning array and in 1972 Pourcelot and his research group developed one of the first real-time ultrasound imaging systems based on the electronic scanning of a linear array. In another area, the Pierre Peronneau group in Paris was engaged in the development of duplex-doppler devices in the late 1960s.

In 1972, with other pioneer's coming from other medical specialities, such as ophthalmology, cardiology an angiology, biophysics and radiology, the French Society for the application of Ultrasound in Medicine and Biology (Société Française pour l'Application des Ultrasons en Médecine et Biologie, SFAUMB) was formed, and becoming a member of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). In 1973 Professor Paulette Jouve and Dr. Cristofari from Marseille reported their preliminary experience in echotomography for the diagnosis of early fetal viability.

Pourcelot and Planiol also were among the first to produce prototype linear array real time scanner at the Tours University in 1972.

Thereafter, the new technique was introduced into the clinical practice of many other obstetrical units, mainly by Bernard Leroy in Saint-Maurice, Roger Bessis and Marie-Cécile Aubry in Paris, Pierre Bourgeot in Lille, Marie-France Sarramon in Toulouse, Alain Potier in Marseille, Hélène Le Guern and Claude Talmant in Nantes and Professor Jean-Marie Duval in Rennes, during the late seventies. Boog left Strasbourg to Brest where he was appointed as Head of the Department of Obstetrics and Gynecology, the development of sonography in Eastern France was assumed by Israël Nisand.

Bernard Benoit in Nice, working in collaboration with Kretztechnik AG, published some of the earliest, most stunning and convincing 3-D images in the mid-1990s using prototype Voluson scanners. His meticulous work and pictures had been singularly important in drawing the attention of many to this new scanning modality.

The teaching of ultrasonography in Obstetrics and Gynecology was first initiated in France by Bernard Leroy and then spread throughout France during the eighties. In 1997, Boog organized with the collaboration of Israël Nisand and the French College of Obstetricians and Gynecologists a nationwide teaching program with an unified list of lessons, a national correction of written questions and a regional control of practical sonographic aptitudes. The certification is now very selective with a success rate of only 50%.

Sonography is now routinely used in obstetrics in France: a recent survey conducted on French pregnant patients in the course of 1998 showed that only 0.2% of women had not experienced a scan during their gestation. The standard of care, obtained on 90.4% of patients, is to perform three examinations, preferentially at 12, 22 and 32 weeks.

Modified and excerpted in part from an original manuscript courtesy of Professor Georges Boog, published here with permission.

Also referenced from: Planiol, T. Historical note: a brief history of the French Society for Ultrasound in Medicine and Biology (SFAUMB). Eur J Ultrasound 1995; 2;2:87-91

Image of Professor Pourcelot courtesy of the Professional College of Saint-aignan, France.

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