Negative impact of different user interface designs in commercial ultrasound systems Kazim Emre Karasahin, Serkan Bodur, Ulas Fidan, Mufit Cemal Yenen Gulhane Military Medical Academy Dept. Ob/Gyn ANKARA TURKEY   Introduction: Manual fetal biometric measurements by 2-dimensional (2D) sonography are an integral part of routine obstetric practice(1). Benacerraf et al(2) reported that the standard fetal anatomic survey can be performed in less than 2 minutes with 3D sonography, and the volumes can be interpreted in 6 to 7 minutes, compared with a mean of 19.6 minutes to perform standard 2D sonography. Clearly, whether 2 dimensional or 3/4Dimensional, ultrasound examinations should not take too long. However, if an ultrasonographer has to use a different Ultrasound machine, especially from a different manufacturer, the time for completing the ultrasound examination increases considerably. Material Method: A PUBMED and a Google Scholar internet search on the subject did not reveal any scientific information regarding this subject. An article mentions about the use of automated systems for measuring basic obstetric measurements, stating that the mean time required to obtain the biometric measurements had been significantly shorter using the automated technique than the manual approach(1) The first author’s 24 years of experience on various ultrasound systems from different companies as an Ob/Gyn and Perinatologist has brought attention on this subject. As would be appreciated by those who have worked on different ultrasound systems from different manufacturers, the user interfaces of ultrasound machines are different. As for the hardware, some has keyboards on the system, and some have them separately. Many uses trackballs, but some don’t , and some had track sticks or even joystick type controls. Sliders may be used, but also trackpads are available on especially the portable systems which started to be more common recently. The position of these control buttons are also placed differently on different systems. Even more complicating than that, data entry and biometric measurement flowcharts are different, because the software of major ultrasound companies are different from each other. Terminology differences or new terminologies brought about by different companies further complicate the situation. Especially in perinatology, where doppler examinations are quite often performed in addition to basic obstetric measurements, the use of doppler controllers, adjusting doppler windows, changing the gate size, gate angle, pulse repetition frequency etc. requires comprehensive knowledge of the hardware and software of the ultrasound system. Otherwise, the time for examination is increased. Also, younger ultrasonographers tend to have more difficulties with the older ultrasound systems. A detailed ultrasound examination of fetus may take a long time in case of suspicion of a pathology. This time may significantly increase if the fetal position or the mother is not in optimal condition, or the ultrasound equipment is not properly set up . Results: A different ultrasound machine is a confounding factor for increased ultrasound examination time. A very expensive new ultrasound machine with extensive 3/4D capabilities can be a disappointment when using on the patient due to the complex pathways and different terminology to be learned in order to get clear images. As very well known, the perfect 2 dimensional ultrasound image has to be obtained to get good volume images. Conclusion: Pregnant women may not tolerate long ultrasound examinations due to hypotensive attacks. Patients sense the lack of control and experience of the ultrasonographer on the ultrasound machine and this would negatively impact the patient trust and confidence, and cause more stress on the ultrasonographer. This may cause a vicious circle ending up in confusion and repeated measurements. We propose that an industrial Standard should be brought on the user interfaces of ultrasound systems and the steps to perform biometric measurements, doppler studies, volume acquiring sequences, volume processing sequences and the system information (probe frequency, pulse repetition frequency, doppler data, ultrasound effects on tissue etc.) locations in the monitor should be standardized. It is suggested that automated biometric methods could substantially shorten the examination time during prenatal sonography and could potentially improve the efficiency of prenatal ultrasound services(1). Automated systems however, bring additional costs to already expensive modern ultrasound systems. Additional studies are required to determine whether automated methods could also reduce systematic errors due to differences in the technique among sonographers (1). References: 1) Does the Use of Automated Fetal Biometry Improve Clinical Work Flow Efficiency? Espinoza, J, Good, S, Russell E, Wesley Lee W J Ultrasound Med 2013; 32:847–850 2) Benacerraf BR, Shipp TD, Bromley B. Three-dimensional US of the fetus: volume imaging. Radiology 2006; 238:988–996