When I just finished the Post-graduate Doctor Course of the Tohoku University, Sendai, in 1965, I was looking for new diagnostic modality for the prostate, because only examination in our hands in those ages was very classical rectal digital palpation, which was introduced in the Greeks’ era.In the early autumn of 1967, I visited a cardiologist in the same University, Dr. Motonao Tanaka, who was a leading researcher of medical engineering. The purpose of visiting was to consult a possibility of my poor idea that some sound from urinary stream in the prostate could be detected, if an electric stethoscope was inserted into the rectal cavity. Occasionally in his laboratory, I found a strange stick. It was a special ultrasonic probe to obtain a section of the heart via the esophagus.
This very new device could not, however, to be used on human subjects, because it caused too much pain to insert into the esophagus. Incidentally and luckily, I became involved in the situation. My poor idea for an intrarectal stethoscope was abandoned at once and we agreed enthusiastically to apply the new device to trying to obtain a prostatic section via the rectum.The very next day, I took a patient with benign prostatic hyperplasia to Dr. Tanaka’s laboratory. After much entreating and some threats he was laid on the bed and the probe was inserted into his rectum. The sonogram of the prostate we obtained was fantastic. This was the first section of the prostate in a living body, of which human had ever seen, because it was 10 years before the commercialization of CT and 20 years before that of MRI. The images looked to me as if it was rose colored!
We published this world’s first image modality for the prostate under the name of “transrectal ultrasonography (TRUS)” in 1968 but following near 20 years had been spent until its generalization as a routine diagnostic modality. Today, however, we can find the “TRUS machine” in any urologic clinic in the world. In October, 2017, the “50 years Memorial Symposium for TRUS” was organized in the WFUMB 2017 Congress in Taipei.
As mentioned in my previous answer, Dr. Tanaka led me into the ultrasound world. At that time, he had already obtained the world’s first ultrasound tomograms of the moving human heart by means of an originally developed ECG-synchronized pulse-projecting ultrasound technique, 15 years before the appearance of real-time ultrasound. According to this technique, ultrasonograms of each phase of cardiac section were taken by a rotation of the angle of ultrasound beam little by little. Though it took more than an hour to record 20-30 sonograms of all phases, the obtained sections were far much clearer than sonograms by real-time scanner in later years. He is still active in research works even now.
Maybe my career highlight in my memory was the establishment of “WFUMB COE (Center of Excellence)”. I served WFUMB as the President from 2000 to 2003. During this period, a matter of ultrasound education for developing countries was often discussed in the administrative councilors’ meetings. The “Global Steering Group for Education and Training in Diagnostic Imaging” in WHO once planned to establish education centers in Africa as the “African project” but no financial resources were found. Moreover, this plan seemed to me as if developed countries favored developing ones from mercy.
So I proposed my specific plan for the establishment of “WFUMB COE”, based upon a principle that “WFUMB only gives the name and local societies organize each education center for ultrasound by their own effort”. The plan was carried in the WFUMB Administrative Council Meeting in Montreal on May 31, 2003, and the first COE was established in Dhaka, Bangladesh, followed by in Kampala, Uganda, during the next year, 2004. The latter one realized the uncompleted plan of the “African project”. Right now, COE has been established in 13 countries in the world and plays one of the most important roles of WFUMB. I thank many people to support this project and to develop this much. Marv Ziskin, the next President, and Byung Ihn Choi, who led the COE Committee after me, were two key persons for this movement.
New technologies appeared in recent years are very much welcome. I think, however, much efforts to refine the image itself should be paid utilizing newly developed functions, because medical ultra-sound is essentially an “image modality”.
Yes, I published two very important works with ultrasound during these several years. The first one was concerned with an active opening function of the human urethra, against the conventional physiology that the urethra has only closure function and the opening is due to a passive motion by urine flow. This finding was obtained by transrectal/transvaginal ultrasound (Int J Urol 2014, 21: 208-11).
The second one was concerned with a fact that the human bladder absorbs at least hundreds mL of water from urine during sleep, which is also against the conventional physiology that the bladder is a simple reservoir and absorbs nothing. We performed the periodical measurement of urine volume during sleep by transabdomi-nal 3-D ultrasound and found a definite temporary volume reduction for several times a night (Int J Urol 2016, 23: 182-7). This concept will give a serious impact to the renal physiology and the etiology of various urological diseases.