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Top-of-the-line imaging gives babies best possible start

Helen Adams | MUSC News Center | July 8, 2015

Miranda Pace
Photos by Sarah Pack
Miranda Pace watches images of her fetus in an overhead monitor as a sonographer does her ultrasound with a new Voluson E10. 

Miranda Pace has traveled more than three hours on a hot South Carolina summer day, but the journey was worth it. The baby growing in her belly has a heart defect, and Pace wants him to get the best care possible. So the Spartanburg woman has come to the Advanced Fetal Care Center at the Medical University of South Carolina in Charleston.

Pace rests in a darkened room as a sonographer does an ultrasound, using a brand-new piece of equipment called the Voluson E10. The $350,000 machine provides amazingly clear 4-D images of the baby Pace plans to name Aidan. He moves around as the sonographer focuses on his heart.

“I like it. It’s pretty cool,” the young mother says of the view she’s getting of her son.

Cool, and important, says the manager of MUSC’s ultrasound unit. Keith Willan says MUSC’s investment in top-of-the-line equipment for fetal imaging, combined with the expertise of its health care team, puts the Advanced Fetal Care Center that celebrated its official opening July 8 at the front of its field.

Keith Willan 

“We’re making diagnoses here that are being made at only a handful of institutions across the U.S.,” Willan said. 

Ultrasounds have been used for fetal exams since the 1950s, but the early sonographers could only dream of the type of high-quality images available now. The exams still uses high-frequency sound waves to produce images, but the technology is improving so quickly that image quality is nearly doubling every five years, Willan said.

That’s great news for parents and their physicians, because the images can show in minute detail any areas of concern. Doctors can keep a close eye on the baby’s progress, intervene when necessary and prepare to take immediate action after the baby is born. Information learned from the ultrasound allows them to assemble a team of the right specialists for each baby, ready to give the little one the best chance at a healthy life.

A sonographer moves a transducer over Esther Bell's stomach at the Advanced Fetal Care Center, using sound waves to create images of the fetus. 

The highest-quality obstetrical ultrasound device on the market right now, according to Willan, is the Voluson E10 made by GE Healthcare. MUSC is adding six to its Maternal Fetal Medicine service this month. They have the best resolution available, along with features that allow MUSC’s team of eight sonographers to manipulate the images in 3-D after exams to get a more in-depth look at anatomical structures.

“We can now see things that we just weren’t able to see before,” Willan said.

Scott Sullivan, M.D., director of MUSC's Division of Maternal-Fetal Medicine, said the machines are important – but so are the people who use and rely on them.

Nurse Practitioner Frances Woodard says goodbye to Esther and Spencer Bell after Esther's ultrasound. 

“You can have a room full of great equipment but not make good use of it if you don’t have great people,” Sullivan said. “We do. All our sonographers are RDMS (Registered Diagnostic Medical Sonographer) certified, which is the highest-level professional certification. All of our physicians are AIUM certified. That’s the American Institute of Ultrasound in Medicine, which certifies us as a high-risk diagnostic unit.”

In other words, the Advanced Fetal Care Center can handle everything from the simplest cases to the most challenging ones, including patients sent to MUSC from other hospitals for its expertise in handling high-risk pregnancies. 

And ultrasounds aren’t the only option for prenatal imaging at MUSC. The center also offers fetal MRIs, which are not available at most hospitals. MRI stands for magnetic resonance imaging. A fetal MRI can give doctors a different perspective on a baby’s condition.

dr. meryle eklund 
Dr. Meryle Eklund 

But pediatric radiologist Meryle Eklund, M.D., who specializes in fetal MRIs at MUSC, says it’s important to note that they’re not for everyone.

“Ultrasound is really the best screening tool for evaluating prenatal abnormalities, but there are some limitations,” Eklund said. “That’s when fetal MRI comes into play, when there’s something you can’t really see with the ultrasound or you want better anatomic delineation of the abnormality, or to provide additional information that can help determine prognosis for the patient.”

She calls fetal MRIs “a window into the womb” that lets doctors examine possibly severe anomalies that need further evaluation.

Fetal MRIs offer a "window into the womb," allowing doctors to examine severe anomalies.   

MUSC does about 25 fetal MRIs a year. The Advanced Fetal Care Center has several radiologists who focus on brain and spine problems, which make up about 80 percent of the cases calling for fetal MRIs. Eklund handles the other 20 percent, which involve problems of the chest, abdomen and pelvis. The radiologists work as a team, sharing images and assessments with each other to ensure every possibility has been considered.

“Sometimes, these abnormalities are syndromic,” Eklund said. “It’s not an isolated, single problem, but multiple problems together that lead to a different diagnosis. So we cross read each other, with different people working together toward a common goal.”

Pace, the young mother who came to MUSC from Spartanburg, didn’t need a fetal MRI. Her obstetrician, Sullivan, said the ultrasound was the best choice in her case, as it is for most women. MUSC does about 900 fetal ultrasounds every month. 

Pace’s baby is due in about two weeks, and the team at the Advanced Fetal Care Center is prepared to act immediately once he’s born, thanks in part to the information provided by the ultrasound.

“We commit ourselves to ensuring this is a world class fetal diagnostic unit,” Sullivan said. “You have to have the best people, machines, the best software, the best imaging equipment, monitors and Internet capabilities so we can move images around. And we have that.”

For more information about MUSC's Advanced Fetal Care Center, call 843-792-4477.


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