Ultrasound for cardiac examinations created a world-class Norwegian industry

The technology used to diagnose cardiovascular disease used by doctors and surgeons worldwide was developed by Norwegian researchers in Trondheim and further developed and manufactured by a Horten-based company, which subsequently became the world’s biggest company in ultrasound.

Frimerke med illustrasjon av ultralydundersøkelser av hjerte
Illustrator: Enzo Finger

Ultrasound equipment was used in diagnostics to measure the blood flow velocity in large blood vessels and in the heart. It simplified heart examinations and gave more reliable diagnoses. Ultrasound is a high-frequency sound that cannot be heard by humans.

We can use it to create images of our internal organs, veins, muscles and so on. It works by moving a sound head that emits sound and receives the echo over the body, which then forms an image (echocardiography). It can receive information about the rate and direction of blood flow, for example when checking whether the blood flow to the heart, or to the womb during pregnancy, is as it should be.

This last method is called Doppler, named after Christian Andreas Doppler who discovered the effect in 1842. It was this method that was developed at what was then the Norwegian Institute of Technology (NTH), now the Norwegian University of Science and Technology (NTNU).

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Indispensable technology

As a PhD candidate at NTH’s Department of Engineering Cybernetics, Bjørn Angelsen conducted the first studies on ultrasound on the heart in 1973, and became a pioneer in ultrasound research. He developed a prototype for blood flow velocity using the Doppler effect to diagnose cardiovascular disease, and introduced heart specialist and researcher Liv Kristin Hatle to the technique. The close collaboration between the fields of technology and medicine proved to be mutually beneficial.

Hatle had already discovered the possibilities of ultrasound technology during a heart specialist congress in London in 1970. She became aware of Bjørn Angelsen’s prototype of a Doppler instrument four years later and understood the potential of the technique in patient diagnostics. One advantage was that it was not necessary to use surgery to cut into a patient's body, i.e. the patient was not exposed to discomfort or risk. In addition, the patient did not need to be admitted to hospital for a heart examination, so it was also a technology that reduced costs and that could be carried out basically everywhere, thus making the space and special equipment needed for invasive examinations redundant.

As a result of trials conducted at the Regionsykehuset hospital in Trondheim, the equipment that measured blood flow velocity was connected to an ultrasound device that creates moveable images on a TV screen. This was the beginnings of Doppler ultrasound technology, which would find its way out into the world some years later. The technology that Angelsen and Hatle contributed to developing is still used today. When the technology emerged, no similar instruments existed. Angelsen and Hatle’s clinical trials of the instrument showed that it was suitable for identifying a narrowing of blood vessels and leaks in the heart valves.

Important new technology often comes into being through developments taking place in different fields at the same time, and where the researchers in such fields or specialist areas at some point meet or hear about each other’s findings. At the same time as Angelsen and Hatle began their collaboration in Trondheim, doctor and engineer Jarle Holen had made progress in Oslo on calculating pressure in the heart from blood flow measurements using a Doppler device.

Angelsen and Hatle have received several awards for their research on ultrasound. Hatle was awarded the Research Council's Award for Outstanding Research in 1996. Together, Hatle and Angelsen were awarded the National Association for Public Health’s ‘heart award’ in 2008 for their contribution to heart diagnostics by way of ultrasound. Hatle was awarded the European Society of Cardiology’s gold medal for her work on ultrasound diagnostics.

Liv Hatle from Finnmark in the North of Norway became a leading and renowned researcher worldwide on the use of ultrasound in diagnostics, and she is probably more known abroad than in Norway. According to her researcher colleague Bjørn Angelsen, ‘Her openness towards new ideas and her long experience as a cardiologist formed the basis of the ultrasound success in Trondheim’ (Forskning 6/1999). She worked on further developing the Doppler ultrasound technology for the rest of her career.

The technology awakened international interest after the researchers presented it at the American Heart Association's annual congress in 1981. The two researchers published a book the following year on the use of ultrasound in heart diagnostics, which is used across the world.

Industry success

The challenge for Hatle, Angelsen and the research environment they worked in was that they lacked equipment and resources for their research. They needed an industry partner to develop the technology. Horten-based company Vingmed became partners towards the end of the 1970s to further develop the technology, and started manufacturing the first Doppler device, Pulsed Echo Doppler Flow velocity meter (PEDOF). Without Vingmed, it is unlikely that the technology would have been developed in Norway, but instead disappear to the USA and other countries, according to Hatle in 2006.

The development of a Doppler ultrasound device with sound and images was the commercial breakthrough for Vingmed. In time, the company was acquired by foreign companies, and eventually by GE Healthcare, which is part of General Electric in 1998, but under the new name GE Vingmed Ultrasound. The company still produces ultrasound equipment, its headquarters remain in Horten, and today, it is the world-leading company in ultrasound equipment for heart examinations.


Bladet Forskning 
Tidsskrift for Den norske legeforening

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