Professor Ian Donald (1910 – 1987)  

Date of Birth            –   Professor Ian Donald was born in Cornwall on 27 December 1910
Family Background –   His father and grandfather had been doctors.
Education                 –   His early education was in Edinburgh, and then in South Africa where he graduated in Arts in Cape Town.

 

 His objectives –

  • Build a new maternity hospital
  • Write a book on obstetrics based on his own experience
  • Perform some really original work.

He was successful in all three.

Positions held –

  • Reader at the Institute of Obstetrics and Gynaecology at Chelsea
  • Professor of Obstetrics and Gynecology in Glasgow at the Queen Mothers Hospital

Milestones –

  • He was a brilliant teacher and his textbook Practical Obstetric Problems went to five editions.
  • Professor Ian Donald often stated preference for the term sonar(which stands for sound navigation and ranging) when referring to ultrasonic echography.
  • His incursion into the study of pregnancy did not begin until 1957. In pregnancy the only echoes of which they could be reasonably sure at that time were those provided by the fetal head. It was this which led him to undertake a series of water tank experiments in which he learned to identify the biparietal diameter and, with later development, its accurate measurement.
  • Rapid and easy diagnosis of hydatidiform mole.
  • By the early 1970s Donalds team began to recognize the phenomenon of ovum blighting and published their findings on the subject in 1972.
  • In 1974 a scan converter and accessories were linked up with Donalds standard Diasonograph B-scanner. This immediately made grey scaling possible. The quality of the pictures as regards organ outline remained as good as ever but also, by different shades of grey, gave a far better indication of tissue characterization. This facility has opened up a whole new avenue of approach, especially in the study of tissue parenchyma. Finally, just before his retirement in 1976, there came on the scene a whole crop of real-time scanning machines.
  • A really important breakthrough occurred in 1963 when a nervous patient presented herself for examination with extremely full bladder. This at once made possible visualization of pelvic viscera, even though not enlarged, since it had the effect of displacing gas containing and therefore impenetrate bowel out of the field and also provided a built-in viewing tank without interfering with the ultrasonic picture. Early pregnancies, normal, abnormal, aborting and continuing could have been studied serially in great detail from the fifth week onwards and they soon collected a mass of material. Donald published the various appearances throughout prenatal development in an article in the Journal of Pediatrics in 1969. 

Invention of Diagnostic Ultrasound - 

  • Professor Ian Donald, by the invention of diagnostic ultrasound, has changed the face of obstetrics and gynecology in the middle of the twentieth century more than any others did. Hardly any area in medicine has experienced such dramatic technical advances during the past four decades as diagnostic ultrasound.
  • The development of high-resolution two-dimensional probes and improvements in color Doppler ultrasound have been critical milestones in the recent history of sonographic diagnosis. Especially in prenatal diagnosis and gynecology, ultrasound has become an indispensable, non-invasive diagnostic tool.
  • Recent technological breakthroughs in diagnostic ultrasound have surpassed all expectations. With these advances, clinicians now have the tools needed to contend with many significant diagnostic challenges.
  • The rapid improvement in ultrasound image quality that has occurred, particularly over the past 10 years, has enabled all to a degree that was thought inconceivable at Donalds time. What is undeniable however are the dramatic changes by the advent of color Doppler, power Doppler and more recently 3D imaging.

 

Speech of Professor Ian Donald at the opening of the School in Dubrovnik in 1982 -

That memorable occasion at the first Ian Donald Inter-University School was vividly illustrated in the following lecture given by Prof. Ian Donald.

 

Prof. Ian Donald during the opening speech of the Ian Donald School in Dubrovnik, 1982.

There is a saying in the English language that some men sow and others reap. It has been my own priceless privilege that I have been allowed to reap what I have helped to sow. This is exemplified today in the foundation of this School of Medical Ultrasound which bears my name. Now, at the end of my days, I could ask for no better epitaph.

 All this is thanks to the University of Zagreb and to Professor Asim Kurjak whose vision of the future has brought about what I would never myself have thought possible. My wife Alix has always been included in these happy Yugoslav meetings and she is with me here today to join me in our best wishes for your success. Asim is a good friend to us all and, like Yugoslavs in general, he gives generous hospitality whose warmth far exceeds what we deserve, but he has also succeeded in bringing together delegates from 17 different countries in fruitful unison. In this respect, this school may stand as a memorial to the preeminence of Yugoslavia in the field of ultrasonic diagnosis.

Any alleged success which I may have had can be attributed to the fact that I was the first to apply ultrasonic techniquest to gynecology and obstetrics. I must also acknowledge the engineering expertise which I was able to enlist in the city of Glasgow.

Being a professor in Scotland is a highly privileged position, unlike in the USA where professors tend to be regarded as a lower form of life. My professional colleagues took a characteristically patient and lenient view of what they doubtless regarded as my eccentricities in those early days. I doubt if I would have got very far in London, for example, and it was my good fortune to happen to be in the right place at the right time. In fact, my original intention away back in 1954 was to seek a more reliable method of differential diagnosis in cases of very gross abdominal distension in females, a common problem in clinical practice in which humiliating mistakes are frequently made by employing the standard diagnostic techniques.

Common causes often pose diagnostic problems because of their very size, for example, gross obesity, massive ovarian cysts, benign as well as malignant, other very large tumors of all varieties – renal, splenic, hepatic, aneurysm, retroperitoneal, genitourinary and involving the abdominal wall – and also all types of ascites, benign as well as malignant. Naturally, pregnancy, as quite the commonest cause of female abdominal distension, came under ultrasonic scrutiny as well, but not initially by us before 1956-57. This was mainly due to the geographic separation at that time of my gynecological unit from my obstetric hospital.

I do not deny that we had our full share of discouraging problems and our early apparatus was laughably crude. As I commented in our first article in The Lancet, what surprised and delighted us was that we got any results at all. You must remember that we had no yardsticks by which to control the rate or method of scanning, or even the best frequencies to use, and it was only the ready feedback of information such as one gets in gynecology, which made it possible to standardize our scanning techniques. Even so, we had very serious technical difficulties 20 or more years ago, such as the unreliability of our sine/cosine potentiometers, poor transducers, no controllable persistence cathode ray tubes, let alone storage tubes and computer storage systems, which today you all take for granted. We worked literally in the dark in more senses than one.

Looking back over what has been a long story of trial and even more of error, I cannot help feel a sense of surprise at all the lucky strikes which have been made over the years and their associated spin-offs. Who, for example, would have thought that our crude early work would have made possible the correct diagnosis of hydatidiform mole within a matter of minutes or that we would ultimately, subsequent to this, have refined the technique to demonstrate the placenta, both its site and its nature. Here I must acknowledge our co-operation with our friends in Denver, Colorado with whom we have maintained a happy liaison over the years. Our experiments in 1961 in measuring the biparietal diameter proved to be the start of all the present sophisticated forms of fetal biometry.

Newcomers to the field of ultrasound must be bewildered as to which sort of apparatus to select. There are many manufacturers, but I have noticed a steadily increasing convergence as to quality of performance as well as price, so that you get roughly what you pay for. Cheap apparatus, cheap results. Expensive apparatus may yield results beyond your clinical needs, so you should think well before choosing.

Much will depend upon the sort of work you want to do, and the available anatomical access. For example, if you want to look deeply into the pelvis at very early pregnancy or for early tumor or even for ripening ovarian follicles, the keyhole approach provided by sector scanners through the full bladder will, in my opinion, give the best results. The same remarks in favor of the sectoized view apply to subcostal studies in the upper abdomen and through the intercostals spaces and particularly in echocardiology, anywhere, in fact, where access is small and the window area requires a sectorized view. The view can be improved considerably if a compound sector scan can be employed which provides an appreciation of the organ under study in its relationship to the rest of the body, particularly the urinary bladder. Unfortunately, the use of sector scanners calls for more skill than the linear array systems which, though providing a blinkered “mouth organ” type of view, are very much easier to handle, especially in the hands of the relative novice who is able, proprioceptively, to appreciate just how well he is lining up his linear array. Their most impressive use is in the middle trimester of pregnancy when the fetus is likely to be no longer than the array system and the abdominal wall will be soft enough to accommodate it throughout its entire length.

The advent of real-time scanners, both linear and sector, has revolutionized ultrasonic diagnosis, chiefly because it not only allows the continuous movement patterns of what is being studied to be graphically displayed and recorded but, even more important, it speeds up the whole process of ultrasonic search. Added to this, various methods of frame-grabbing or framefreezing can be employed which provide static records for later scrutiny. This facility enormously increases the throughput of patients, since it speeds up the whole examination. The various storage, recording, and photographic systems are mainly responsible for the differences in price between one apparatus and another.

A real-time scanner can be combined with a static compound sector scanner. There is a choice of sector scanners between the wholly electronic phased-array system's, which are expensive, though very compact, and particularly useful in cardiology, and the combined mechanical and electronic systems employing either spinning rotors with several transducers or rockers, either transducer crystals or mirrors. The linear-array systems are all electronic and without moving parts, as in the case of phased array scanners. As they say in English slang, “You pays your money and takes your choice”.

It distresses me that there are sometimes arguments about who should be in control of ultrasound scanning – just like dog’s squabbling over a bone. Naturally, I now expect you all to be so much better at the ultrasonic art than me, so that I can safely withdraw into my old age. But I do recognize that there are many disciplines involved. On the whole, in medical sonar, there has been a happy club-like liaison between clinicians, radiologists, radiographers, physicists, engineers, embryologists, geneticists and technical staff of all types. Each has something to contribute and I feel strongly than no one group should exclude another, whatever money-obsessed administrators may feel. For goodness sake, let us keep it that way.

 

Dubrovnik, Croatia, headquarters of the Ian Donald School of Medical Ultrasound

Speaking of myself, I can say that the specialty has brought us many friends from all over the world, and sonar has built an intellectual bridge between East and West, as well as a bridge between medicine and engineering. The existing liaison between Yugoslavia and Egypt provides a very good example of international co-operation, largely thanks to Asim Kurjak and Maher Mahran.

It is interesting that the scope of interest has now extended to the veterinary world, and next month I have to lecture to an audience mainly interested in racehorse breeding – a very lucrative subject, I should imagine.

The ability to diagnose a number of fetal developmental defects in the first half of pregnancy was, I suppose, inevitable. This facet, to me at least, is one of the sadder aspects of this work since, so far, so little can be done in the curative sense and the offer of termination of pregnancy is the most that one can suggest. From all this, there has grown a natural tendency to institute a sort of witch hunt, especially in the case of older pregnant women who are at statistically greater risk. The unhappy dilemma, often unnecessarily inflicted on our patients, has to be reckoned with in advocating massive screening program. As I have already hinted, it is perhaps time I withdrew.

One of my constant nightmares of years ago was that someone, one day, would conclusively show that sonar did some unexpected and unforeseen harm to the developing fetus, in spite of my own efforts and that of others to verify the safety of the technique. The subject has greatly exercised my mind since the very beginning and, in the book I wrote with Salvator Levi in 1973, I dealt at length with all that was then known about possible bioeffects. I have seen nothing fresh of much significance 6 Donald School Textbook of Ultrasound in Obstetrics & Gynecology since then. Meanwhile, hundreds of thousands of babies must by now have been screened by sonar all over the world and still there is no sign of trouble.

Surprising enough, legal liability seems to have turned in the opposite direction, and a doctor is more likely now to be prosecuted for failing to make use of ultrasonic diagnosis in pregnancy in cases where a baby’s misfortune or handicap is alleged to be due to negligence in this respect. The well-recognized uses, however, so far outweigh theoretical hazards for which there is as yet no convincing proof that the subject has become truly entrenched in the clinician’s diagnostic repertoire.

For me personally, the ultimate climax to the ultrasonic art with which I have been associated is the filming of very early fetal life. To be able to study in real time a baby’s reactions to all manner of stimuli opens up an enormous field of dynamic research which is, as yet, barely touched upon. I leave this exciting field to you.

When a pupil can teach his teacher, as I now recognize, then it is not only time to stop but also to rejoice at the newly found success of his one-time disciple. For myself, I do not think that I deserve more acknowledgement than a man who happens to win a football pool. Nevertheless, I trust that I may be forgiven for feeling proud of so many of you, proud to have been invited here with my wife to this opening, proud of who and what you are and proud of what I know you will achieve.

Thank you!