Jason Birnholz

Jason Birnholz
Massachusetts Institute of Technology | MIT

MD

About

131
Publications
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Introduction
Jason Birnholz is working on and lecturing about advanced clinical applications of fully digital, dynamic beam former, compact ultrasound imaging systems.

Publications

Publications (131)
Article
Full-text available
Application of Thinking fast and slow to radiology education and ultrasound practice
Conference Paper
PURPOSE Ultrasonic measurements are used routinely for gestational age (GA) determination and forward projection of an expected average (40 week) due date. Ultrasound has been established as the most accurate form of dating in spontaneous pregnancies.These data can be used to back project the date on conception with comparable precision. METHOD A...
Conference Paper
PURPOSE Embryonic age is estimated ultrasonically from body (i.e. crown rump) length (EL), which may be difficult to measure precisely when length is a low multiple of wavelength. Heart rate (HR) increases with length and with conceptual age during the first two months of pregnancy. We have studied the relation between HR and EL during this epoch a...
Conference Paper
PURPOSE Cardiac generated arterial pressure is the sole motive source for placental blood flow. A consequence of this model is the potential for noninvasive, in vivo estimation of combined cardiac output, stroke volume, and other indicators of cardiac function in the third trimester fetus from umbilical vein flow velocity, vein area, and heart rate...
Conference Paper
HTML Purpose: Congestive heart failure (CHF) is identified in the second and third trimesters of pregnancy as fetal hydrops and hydramnios. The occurrence of CHF has not been established in the first trimester. Endovaginally acquired pulsed (and tissue) Doppler are applied to evaluation of myocardial mechanics in early pregnancy. Methods and Materi...
Article
OBJECTIVE: Our objective was to describe the antenatal growth of the corpus callosuni in uncomplicated pregnancies as visualized by ultrasound. STUDY DESIGN: The length of the corpus callosum was measured in the sagittal plane in 1058 sonographically normal fetuses from 13 to 38 weeks gestation using magnification ultrasound imaging. A 7 MHz, 19 mm...
Article
OBJECTIVE: A deterioration in accuracy of gestational dating from standard ultrasound measurements has been ascribed to intrinsic biological variabiliu among fetuses as pregnancy progresses. We sought to determine the degree of biologic variability found among third trimester fetuses when a careful standard of measurement is employed. METHODS: Ultr...
Article
Our purpose was to evaluate effects of multifetal pregnancy reduction on pregnancy complications and birth weights of remaining twin fetuses compared with expectantly managed triplets and nonreduced twins. Medical records of 54 triplet pregnancies, 59 twin pregnancies resulting from multifetal pregnancy reduction, and 88 sets of twins conceived wit...
Article
Amniotic fluid volume was estimated sonographically in 507 of 977 first trimester pregnancies with living fetuses and in 99 of 227 instances of missed abortion. Volume is correlated with fetal length, cross referenced by average heart rate for living fetuses. Fluid volume increases exponentially after 9 weeks, consistent with the onset of renal fun...
Article
Current instrumentation provides capabilities for minute fetal anatomic exploration and for integrative physiologic inference. This extends the complexity of the study and the diagnostic obligation of the examiner. The direction of study and clarification of findings devolve increasingly upon pathology and pathophysiology rather on than prior imagi...
Article
The respiratory functions of the oropharynx, larynx, and trachea of normal human fetuses in utero were explored by means of real-time, two-dimensional ultrasonography combined with color-flow and spectral Doppler analysis. Coronal and transverse images revealed the maturation of coordinated respiratory activity of these structures in the late secon...
Article
Supply-line deprivation is a major source of developmental fetal pathology. Clinical surveys have tended to emphasize the role of placental failure, although the umbilical cord may also be a site of injury. Supply-line limitations are met by a series of active fetal compensatory maneuvers. These include growth retardation. The role of ultrasound is...
Article
Full-text available
Dr Birnholz, Department ofRadiology, Rush-Presbyterian-St. Luke’s Medical Center Chicago 60612CHEST I94 6 DECEMBER, 1988 127513Willford ME, Hidalgo H,Putman CE, Korobkin M,Ram PC. 16Saito T,Kobayashi H,Sugama Y,Tamaki 5,Kawai T,KitamuraComputed tomography ofpleural disease. AJR 1983; 140:909- S.Ultrasonically guided aspiration biopsy inthe diagnosi...
Article
A prenatal standard for ear length was developed from ultrasonic images of 180 normal subjects. Length increased from about 6 mm at 15 weeks to 33 mm at term and was well fit by linear regression (r2 = .96). Short ears (greater than or equal to 1.5 SD below gestational age average) were associated strongly, and specifically, with chromosomal disord...
Article
Ultrasound imaging has evolved technically. Large-aperture, multielement array systems achieve improved spatial, contrast, and temporal resolutions. These advances are useful for detailed study of the endometrium, especially for early detection of neoplastic disease and premalignant risk factors, assessment and management of infertility, monitoring...
Article
Large-aperture, dynamically focused ultrasonic imaging permits noninvasive, anatomic study of the eye at the millimeter level in the second and third trimesters of pregnancy. The authors report their observations of the hyaloid artery in 210 of 219 fetuses examined with this technique. This vessel is seen in fetuses of 20 weeks gestational age or l...
Article
The diagnosis of multiple pregnancy can be made confidently in most instances 4 to 5 weeks after conception. The fetus and yolk sac are visualized by that time, and cardiac motion is observed. In practice, patients treated for infertility will have been monitored closely for signs of pregnancy and will likely have ultrasound studies relatively earl...
Article
The prenatal diagnosis of hydrocephalus is described in 11 cases between 17 and 21 weeks using two sonographic criteria. These sonographic findings involve the asymmetrical appearance of the choroid plexus and the size and configuration of the anterior horns of the lateral ventricles. We have found that these criteria can accurately diagnose fetal...
Article
Ultrasonic imaging diagnosis has become more sophisticated as instrument performance has advanced and as the educational base of its practitioners has extended. By and large, the method is used qualitatively to answer specific medical questions, usually those involving anatomic features delineated by fluid spaces or involving local changes in tissu...
Article
We report a case of a cervical teratoma that was diagnosed prenatally. In anticipation of potential upper airway obstruction, resources were mobilized to the operating room at the time of planned cesarean section. The neonate developed respiratory distress, and her airway was secured. There was no evidence of cerebral anoxia initially, and she is c...
Article
The area of functional human fetal brain development is largely terra incognita for obvious technical reasons. There have been several elegant fetal anatomical studies, but these have been simple point samplings of necropsy material with a potential bias on studies of fetal or maternal—fetal conditions associated with early delivery. A large number...
Article
Intraoperative ultrasound was used as an adjunct in difficult dilatation and evacuation (D&E) procedures for first-trimester abortions. This technique was useful in eight technically difficult D&Es in the presence of acute retroflexion, acute anteflexion, cervical stenosis and lower uterine segment fibroids.
Article
A flexible model is proposed for estimation of fetal weight from biparietal, occipitofrontal, and average abdominal diameters and femoral shaft length. Individual formulas are selected by gestational age-independent decision rules that reflect fetal body proportions. The correlation coefficient for observed and predicted weight was .994 in a series...
Article
Ultrasound (US) can be used to visualize vertebral segments, suggesting a quantitative means of studying vertebral column growth in utero and thus a means of detecting developmental abnormalities. US images of the lumbar spine were obtained in 128 clinically normal fetuses between the gestational age of 11 through 41 weeks. A large-aperture, dynami...
Article
We report a case in which a cervical teratoma was diagnosed antenatally in the mid third trimester. In anticipation of potential upper airway obstruction, resources were mobilized to the operating room at the time of the planned cesarean section. The neonate was unable to breathe, but his airway was secured without delay. There was no evidence of c...
Article
The fetal eye is studied ultrasonically during the second and third trimesters with a large aperture, dynamically focused imaging system. The globe, lens, iris, pupil, and cornea can be resolved separately, and extraocular structures including muscles, retro-orbital fat, and optic nerve may be visualized. The hyaloid artery is seen before 20 weeks...
Article
Fetal lung maturation involves a number of separate developmental processes. An ultrasonic technique is reported for grading the dynamic behavior of the right middle lobe or lingula in the second or third trimesters on ultrasound (US) study. Fetal lungs are stiff initially. Lung compressibility during diastole is typical after 36 weeks' gestational...
Article
We report the application of an orthogonal ultrasonic guidance technique for renal biopsy in which the needle is visualized continuously throughout its placement. This method was initially developed for intrauterine fetal transfusion, and its use has been reported for transuterine fetal procedures and amniocentesis.
Article
Parenchymal edema is one of the patho-physiological results of the renal allograft rejection process. We report three instances of edema visualized within the renal pelvis at the clinical peak of acute rejection, representing a late, but highly specific, sign of this condition. Its occurrence does not imply clinical irreversibility.
Article
We report the coordinated metabolic, hormonal, and reproductive data of a female channel swimmer during the pre-swim training period, immediately post-swim, and in the post-swim untrained state. Urine and blood samples collected at these times were assayed for diurnal urinary catecholamines, urinary C-peptide and 3-methylhistidine, total blood keto...
Article
Seventy-one parents and 40 siblings of 41 index patients with bilateral renal agenesis, bilateral severe dysgenesis, or agenesis of one kidney and dysgenesis of the other were evaluated by gray-scale ultrasonography for genitourinary malformations. Nine per cent (10 of 111) had asymptomatic renal malformations, most often unilateral renal agenesis...
Article
Full-text available
Article
The eyelids, midface, and mouth are monitored ultrasonically during transuterine vibroacoustic stimulation. The test sequence is an "orienting", .5 second noise burst (150-1600 Hz, 100 dB), followed after 30 seconds with 10 bursts spaced one second apart.We have shown previously that motor responses begun abruptly at 24½ weeks gestational and are e...
Article
Newer ultrasonic imaging systems with submillimeter resolution enable visualization facial details. The bony skeleton is observed from 11 weeks gestational age, the optic globes from 15 weeks, and the remaining soft tissues, progressively, after 18 weeks.
Article
Evaluating the fetal lung is a component of the ultrasonic assessment of newborn viability. We have combined subjective ultrasonic visualization of the lung with quantitative parameters including the ratio of cross sectional areas of the heart and thorax, average rib spacing (midaxillary line), relative lung reflectivity, and the occurrence and pat...
Article
Ultrasonic imaging has not been used for primary visualization of brain parenchyma in fetuses or neonates, although it is applied routinely for evaluation of ventricles (and other fluid collections) and for the detection of intracranial hemorrhage and neoplasms. We have begun investigating cerebal parenchymal appearance directly with a large apertu...
Chapter
Circulating immune complex (CIC) levels were measured by a polyethylene glycol turbidity assay in patients with molar pregnancy to investigate the relationship between CIC and trophoblastic tumor burden. At the time of presentation, CIC values were in normal range in 27 (87%) of 31 patients with molar pregnancy. Three of the four patients who prese...
Article
Blink-startle responses to vibroacoustic stimulation were monitored ultrasonically in human fetuses of known gestational age. Responses were first elicited between 24 and 25 weeks of gestational age and were present consistently after 28 weeks. Defining the developmental sequence for audition provides a foundation for diagnosing deafness and recogn...
Article
Fetal sex was determined ultrasonically by visualization of the external genitalia with 99 per cent accuracy in 69 per cent of 855 consecutive fetuses of 15 or more weeks' gestational age. Definitive visualization of the external genitalia was achieved in more than 90 per cent of all cases after the fifth month. We also found that testicular descen...
Article
Septum pellucidum fenestration is demonstrated ultrasonically in a 22-week-old fetus and a 2-month-old infant.
Article
The ridge pattern of the external ear was evaluated in 50 normal subjects during the second half of pregnancy. Definition was found to progress with gestational age, with a fully defined pattern implying maturity beyond 33 weeks. The external ear was edematous in patients with severe fetal hydrops. Anomalous shape or unusual prominence of the ear w...
Article
Pelvic ultrasonography was performed in 33 patients with persistent gestational trophoblastic disease (GTD) and the sonographic findings were compared in all patients with laparoscopic findings and histologic material from endometrial curettage and/or hysterectomy. Ultrasonography indicated trophoblastic uterine involvement in 17 patients (51.5%) a...
Article
Endometriosis and inflammatory disease together are the most common gynecologic problems of reproductive-age women. This article considers. the clinical and sonographic manifestations of endometriosis and pelvic inflammatory disease. Endometriosis presents clinically and sonographically in two distinct forms. Involvement may be diffuse with multipl...
Article
WE HAVE previously shown that serial percutaneous cephalocenteses could be accomplished safely with continuous ultrasound guidance.1 This method provides only transient relief of elevated intracranial pressure because of prompt fluid reaccumulation. It is apparent that a continuous form of decompression will be required for effective antenatal trea...
Article
Anatomic localization and diagnostic inspection of the gallbladder are achieved in 30–60 s with the use of a recently developed electronic sector scanning ultrasound imaging system. Approximately 98% visualization is achieved without patient preparation or selection. In a prototype survey of 766 patients, cholelithiasis was detected in 43 of 130 su...
Article
The cerebellum can be visualized ultrasonically in preterm and full-term newborn infants. A cross-sectional area measurement of the central portion of the vermis correlated with gestational age (r = .98) when growth was normal (N = 51). Central vermian area was decreased in small-for-date newborn infants (N = 10) but was normal in large for date (d...
Article
One hundred and twenty-four patients underwent prospective preoperative examination of the scrotum with an advanced, commercial B-mode imaging system. There was reliable distinction between simple hydrocele and complex fluid collections. Particular attention was directed toward the problem of neoplastic disease mimicking, or masked by, clinical fea...
Article
Full-text available
Article
There are many clinical situations in which diagnostic information is sought from an abundance of numerical material. Information is conveyed by the absolute deviation of individual values, given a knowledge of the normal statistical and biological variation of that parameter and also by the associative patterns of those individual values. Translat...
Article
Seven patients with processes involving the psoas muscle are presented. These included psoas abscess (3), metastatic tumor and abscess (1), lymphoma (1), and psoas hematoma (2). The role of radiologic studies in the diagnosis and management of these patients is discussed with particular reference to ultrasound and computed tomography.
Article
Age at menarche and menstrual periodicity of 21 college swimmers and 17 runners were studied in relation to the age of initiating training. The 18 premenarche-trained athletes had a mean menarcheal age of 15.1 +/- 0.5 years, whereas the 20 postmenarche-trained athletes had a mean menarcheal age of 12.8 +/- 0.2 years, similar to that of the college...
Article
The eye can be visualized ultrasonically in more than 90 percent of fetuses 16 through 42 weeks of gestational age. Slow eye movements are present by 16 weeks. Rapid eye movements begin at 23 weeks and become more frequent between 24 and 35 weeks. Eye inactivity becomes more common after 36 weeks and is associated with sustained diaphragmatic excur...
Article
The results of intrauterine transfusion in 365 consecutive fetuses with erythroblastosis fetalis, between May 1, 1964, and December, 1979, are reported. The gestational ages of the fetuses at initial transfusion ranged from 22 to 33 weeks. The criteria for transfusion were established by optical density measurements on amniotic fluid supplemented b...
Article
PERCUTANEOUS cephalocentesis without ultrasound is used as an adjunct to the delivery of a fetus with massive cranial enlargement due to hydrocephalus.1 The procedure carries substantial risks of fetal morbidity and is selected when cranial dimensions preclude uncomplicated vaginal delivery. Precise antenatal evaluation of the intracranial anatomy...
Article
This article has no abstract; the first 100 words appear below. Obstetric-Ultrasound Quadriga Obstetric ultrasound is a procedure without a clearly defined identity. Should it be part of radiology, because it involves diagnostic imaging? Or should it be part of obstetrics, perinatology, or neo-natology, because of the subject matter? From an academ...
Article
Ultrasound-facilitated intrauterine transfusion was performed on 35 fetuses. Eleven fetuses were hydropic and less than 26 weeks' gestation at the time of the first intrauterine transfusion (IUT). Only two (18%) neonates survived. Twelve fetuses were not hydropic and less than 26 weeks' gestation at time of IUT. Six (50%) neonates survived. Correct...
Article
A rapid examination method for female subjects with acute pelvic pain was developed for potential clinic or emergency distinction of medical and surgical disorders. A 95% diagnostic accuracy was achieved in separating retrospectively 102 consecutive patients into "hospital" or "outpatient" categories. It is recommended that ultrasound be used routi...
Article
Transabdominal craniocentesis for the decompression of an advanced hydrocephalic fetal skull was performed under high-speed, sector scanning ultrasonic guidance. This technique can be used to facilitate delivery of a hydrocephalic fetal skull via the vaginal or abdominal route. The ability to monitor internal landmarks while advancing the needle is...
Article
Fetal weight is estimated in vivo from ultrasound image measurements. Serial study of weight growth defines a trajectory which has physiologic and clinical significance. Low order polynomial fits to these data provide a functional description of the growth process which may be used for recognition and characterization of distinct growth patterns.
Article
In a series of 526 consecutive, unprepared patients examined by ultrasound, the gallbladder was visualized in 507 (96%). The average wall thickness was 2 mm or less in 97% of asymptomatic subjects without cholelithiasis and 3 mm or greater in 45% of those with choletithiasis. Pathologic correlation of increased thickness and chronic cholecystitis w...
Article
Immunologic renal allograft rejection is the most common cause of diminished renal function in the transplant patient, yet it is difficult to distinguish from other etiologies, frequently requiring biopsy before therapy can be instituted. To determine the utility of ultrasound in the diagnosis of this type of rejection, the authors correlated histo...
Article
Twenty-two patients, 19 of whom presented with first trimester bleeding, underwent ultrasound examination demonstrating a normal amniotic cavity containing a fetus with regular heart activity. In each, a separate anechoic or hypoechoic region was identified within the uterus compatible with a coexistent anembryonic pregnancy or "blighted twin." Thr...
Article
A newly developed high-speed ultrasound imaging system enabled accurate observations to be made of fetal respiratory movements in utero. Visual monitoring of data acquisition eliminated artifactual recording.
Article
Continuous ultrasonic observation of needle placement for aspiration, biopsy, or catheter placement is a novel and specific use of phased array imaging. In the case of IUTx, catheter placement into the fetal peritoneal space is accomplished rapidly, with reduced risk of fetal trauma, and without exposure to ionizing radiation. Experience with 27 tr...
Article
A large, calcified paratracheal mass was identified in a patient with secondary hyperparathyroidism. The mass proved to be a giant, calcified, cystic, hyperplastic parathyroid gland. Radiographic and ultrasonic imaging techniques were quite useful in diagnostic evaluation. Whenever a calcified mediastinal or neck mass is discovered, especially in a...
Article
Full-text available
Phased-array ultrasonography provides a means for continuous observation of moving structures. This method can be used for assessing fetal movements from the middle of the first trimester. Eleven separate spontaneous movement patterns were defined in 40 examinations of clinically normal women (6 weeks to term). A trend of increasingly complex movem...
Article
Continuous observation of fetal movement patterns is a novel and useful capability of new high-speed ultrasound imaging systems. Confirmatory documentation of human fetal breathing as a component of these movement patterns has been achieved using a phased-array real time ultrasound sector scanning system. This system permits direct visualization of...

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