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The Story of The Development of Noninvasive Heart Care

    New article traces contributions of an engineer and physician collaborators looking to assess the heart from the outside in

BETHESDA, Md. (September 14, 2009) - Fifty-one years ago the average American home cost $30,000, Elvis Presley wooed listeners with Hard Headed Woman, and the hula hoop was introduced. That same year, 1958, a team comprised of a groundbreaking engineer -- Dean Franklin -- in concert with two exceptional physicians -- Drs. Robert Rushmer and Robert Van Citters -- was laying the foundation for what would eventually become a radical new approach to health care: the noninvasive imaging and treatment of the heart. The discoveries of these pioneers would eventually lead to a doctor's ability to see the heart without cutting open the body; allow patients to have their hearts monitored despite being miles away; and provide reassurance to parents that a fetus' heart was normal rather than waiting until the offspring was born.

The details of these efforts are chronicled in a new article, "Standing on the Shoulders of Giants: Dean Franklin and His Remarkable Contributions to Physiological Measurements in Animals," by R. Dustan Sarazan and Karl T.R. Schweitz. The article appears in the September 2009 edition of Advances in Physiological Education (http://advan.physiology.org/cgi/content/full/33/3/144). The American Physiological Society (APS; www.the-aps.org) publishes the quarterly journal.  The APS has been an integral part of the scientific discovery process since it was founded in 1887.

Dean Franklin: Ultrasound, Ultrasonic Transit Flow Meter, and Doppler Flow

Dean Franklin was a teenager during World War II, but was drafted in 1950 and selected for training in radar. He subsequently became chief instructor in the U.S. Army's advanced radar school. In 1952, he was recruited by Boeing to work on the BOMARC missile project and was later hired as an electronics technician in the laboratory of Robert Rushmer at the University of Washington Medical School.

Initially, Franklin's role was limited to fabricating the Whitney gauge, a relatively crude device that could be attached to a dog's heart tissue to measure cardiac dimensions. At the time, Rushmer was pioneering the concept of collecting cardiovascular data from conscious animals with implanted instrumentation, instead of the unconscious, open-heart animals that were the standard. While working in Rushmer's laboratory Franklin melded what he learned about the cardiovascular system with what he had learned about radar during his military service. With the support of Dr. Rushmer, a pediatrician and physiologist with a great interest in the heart, they were able to develop ultrasound instruments to measure blood flow, despite the prevailing view of the late 1950s that ultrasonic measurements of blood flow were impossible. Franklin's device was successful enough to be among the first breakthroughs to use ultrasound for physiologic measurements. It was used, for the first time, on conscious animals and eventually humans.

By 1962, Franklin and a colleague had invented the first fully functional ultrasonic transit time flow meter, which measures blood flow in intact arteries; the sonocardiometer, which measures the dimensions of the heart; and the ultrasonic Doppler flow meter, which measures the velocity of liquids containing suspended particles such as red blood cells. As a result of these developments, a new generation of scientists launched the first noninvasive ultrasound imaging devices, which are now the industry standard in human medical technology. These devices are descended directly from Franklin's first flowmeter and sonocardiometer. 

Scripps Clinic and the San Diego Zoo

That same year, Franklin joined Robert L. Van Citters at the Scripps Clinic in San Diego and established a relationship with the San Diego Zoo. Through this arrangement, the researchers had their first opportunity to work with animals other than dogs. While at Scripps, Franklin designed and built the first telemetry device for remote monitoring of physiologic signals (other than temperature). It was first tested on an exercising boxer dog at the Zoo hospital and subsequently was used for telemetry experiments in baboons and a variety of other animal species across the globe. The telemetry widely used in hospitals that we know today evolved from these experiments.

Out of Africa, Into Alaska

After three years at Scripps, Franklin and Van Citters conducted telemetered experiments in Kenya for the purpose of understanding the effects of exercise in baboons in their natural habitat and the unusual hemodynamic issues confronted by giraffes with the large hydrostatic pressure gradient between their heads, their hearts and their feet. The pair was successful in developing and implanting tiny devices in the heart that the animals could wear for long periods. The devices, small implantable blood pressure transducers, Doppler flowmeters and a radio telemetry system, were surgically implanted, the animals recovered and the experimenters  were able to carry out long distance monitoring of blood pressure in the animals.

Franklin and Van Citters continued to focus more sharply on the physiology of exercise, especially the distribution of blood flow to various organs during extreme exercise. Classic physiology predicted a reduction in renal flow during a fright reaction, though in one of the African experiments, a baboon was threatened by a giraffe but its renal flow did not change. Nor did it change among treadmill-exercising dogs in experiments previously conducted in Rushmer's laboratory.

Ultimately, Franklin and Van Citters used their telemetery systems to study Alaskan sled dogs, similar to those in the famous Iditarod race. They traveled to Alaska and instrumented several dogs, surgically inserting flowmeters and pressure gauges. After the dogs recovered from surgery and were reconditioned to their previous exercise capacity, their performance was tested. They were able to run 20 consecutive 4-minute miles without showing any sign of exhaustion and no evidence of blood flow deficit to visceral organs, even during extreme exercise.

Watch the Developments Unfold In Photographs and Video

To watch the story unfold, view photographs and videos online. The archives include: 

Photographs

  • An instrumented dog exercising on a prototype Quinton treadmill at the University of Washington in the 1950s. The differential transit time flowmeter chassis on the right was mounted so that Dean Franklin could access the electronic components. (Photo 1)

  • The ultrasonic differential transit time flow probe that was used to collect the first in vivo blood flow signal from a conscious animal in 1958. (Photo 2)

  • An early prototype of a transit time flow probe, fabricated by Franklin, which contains two crystals on one side and a reflector on the other. This design was independently developed later by others and has become the industry standard. (Photo 3)

  • The first telemetry device to transmit a hemodynamic signal from a free roaming animal. It was used on a boxer dog at the San Diego Zoo hospital in 1963. (Photo 4)

  • Aortic blood flow velocity transmitted by a boxer dog outside the San Diego Zoo hospital and received inside the building. (Photo 5)

  • Devices (variable inductance pressure transducers) that were implanted in dogs in Rushmer's laboratory in the l950s. Each device was handmade by a machinist in the University of Washington instrument shop. (Photo 6)

  • One of the first prototype implantable pressure transducers that was used in the baboons and giraffes in Africa. Improved versions of this prototype subsequently became known as Konigsberg pressure transducers, which are still in use.  (Photo 7)   

  • Telemetry studies using a VW bus equipped with standard consumer high fidelity audio equipment to record Doppler flow signals from instrumented dogs. (Photo 8)

  • Classic exercise physiology studies conducted near San Diego California. The instrumented dog was encouraged to chase the vehicle containing the telemetry receiving and recording equipment by the person sitting in the rear hatch (notice the legs and feet). (Photo 9 )

  • Schematic of a remote controlled anesthetic capsule designed by Van Citters and a colleague to recapture instrumented baboons. (Photo 10)

  • Photograph of the anesthetic device described in photo 11. (Photo 11)

  • Instrumented sled dog team at Ft. Wainwright, Alaska. The last dog in the team was wired to the transmitter equipment in the sled for remote collection of data. While all dogs were instrumented, only one was studied at a time.  (Photo 12)

Videos

  • Video 1 - "Ole Number Seven". Exercise studies with an instrumented greyhound and boxer. Note the consumer hi-fi electronics used for the Doppler telemetry signal reception. Franklin joked that they put different numbers on each side of the dog to achieve an N of 2.

  • Video 2 - Exercise studies in the California desert. Instrumented dogs were encouraged to run behind Dean Franklin's personal VW bus by a member of the laboratory sitting in the back hatch.

  • Video 3 - Baboon telemetry backpack used in the Kenya expedition in 1965. This backpack was designed and built for this expedition by Nolan Watson of the University of Washington. On the left is Robert Van Citters; on the right, Dean Franklin.

  • Video 4 - An instrumented baboon blending in with other members of the herd. Notice the red/white backpack on the instrumented animal. Animals were subsequently recaptured by remotely activating a subcutaneous anesthesia capsule containing phencyclidine (PCP).

  • Video 5 - Example of the process for capturing a giraffe. In the first part of the video, a previously instrumented giraffe is being recaptured to recover the instrumentation. The carotid artery was resutured and the skin closed, and the animals were released back into the environment. The second portion of the video depicts another giraffe recovering from instrumentation surgery and being released.

  • Video 6 - Instrumented Alaskan sled dogs at Fort Wainwright, Alaska. Although all the dogs had been surgically instrumented during a previous trip to Alaska, only one was connected to the transmitting equipment in the sled for study at a time. The wrapping containing the external equipment can be seen on one of the dogs nearest the sled.

Collaboration Leads to Healthy Hearts

Dean Franklin's work with ultrasound, the Doppler flow meter and the sonomicrometer helped establish the field of medicine that is now known as noninvasive clinical echocardiography. His accomplishments could not have been realized without collaborating with Robert Rushmer and Robert Van Citters and a broad supporting cast of engineers, physiologists, fellows, technicians and animals. The collaborations that began 51 years ago paved the way for the countless number of healthy hearts that beat today.



To schedule an interview with article co-author Dr. Sarazan please contact Donna Krupa at 301.634.7209 or DKrupa@the-APS.org.

    

Physiology is the study of how molecules, cells, tissues and organs function in health and disease. Established in 1887, the American Physiological Society (APS) was the first U.S. society in the biomedical sciences field. The Society represents more than 10,500 members and publishes 15 peer-reviewed journals with a worldwide readership.