Jack Jellins AM PhD (Hon)MD: Ultrasound and Education

Historical Article
 
Engineer, Research Scientist, and Educator – Pioneer in Ultrasonic Imaging and Continuing Contributions to International Education.

(Prepared by Laurie Wilson PhD Adjunct Professor, School of Computing Engineering and Mathematics, Western Sydney University)

 

 

Jack Jellins is a name familiar to members of the Australian ultrasound community especially to those approaching retirement age as Jack’s contributions were in the early days when this imaging technology were evolving. Jack was a member of the team of engineers and scientists engaged in ultrasound research at the Ultrasonics Institute (UI) in Sydney. The Ultrasonics Institute had a unique position in the world of medical imaging, and contributions were made in a number of clinical areas where ultrasound has distinct advantages over other imaging modalities. Jack was responsible for leading research programmes in the ultrasonic imaging of the breast, thyroid and scrotum, and his contributions over a 25-year period from the mid 1960s to the end of the 1980s were significant in the introduction of this new imaging technology into mainstream clinical practice. When the Ultrasonics Institute became part of the Radiophysics Division of CSRIO in 1989, Jack underwent a career change that took him into the world of international teaching. This provided Jack with the opportunity to share his scientific and clinical knowledge in the wider medical community where breast ultrasound imaging was being evaluated. Together with a number of colleagues in the early 1990s, Jack formed the International Breast Ultrasound School (IBUS) in Europe, and in 2016, the school celebrated its 25th anniversary having provided more than 120 courses to over 12,000 participants.

Today, Jack still continues to contribute to IBUS activities, and this organization has achieved the recognition of being the leading international provider of breast imaging courses.

Born in Vienna, Austria, Jack arrived in Australia after World War II where he attended schools in Goulburn, Galston, and Randwick before graduating from the University of Sydney in Science in 1960, and Electrical Engineering in 1961. After a brief spell with the Royal Australian Naval Experimental Laboratory in Sydney, and a year with Barringer Research Pty. Ltd., a company developing magnetometers for geophysical exploration, Jack looking for new challenges joined the Ultrasound Research Group of the Commonwealth Acoustic Laboratories in 1965. This group was set up under the leadership of George Kossoff in 1959 to research medical ultrasound, and in 1975 became known as the Ultrasonics Institute (UI).

In the mid 1960s, ultrasound imaging was in its infancy and expanding into new clinical applications. A research scanner designed by George Kossoff and David Robinson dedicated to breast imaging was ready to be installed in 1966 at the Royal North Shore Hospital in St. Leonards, and Jack with his background in engineering and physics was given the role of investigating the use of ultrasound for breast imaging. The scanner design utilised a water bath for coupling between the transducer and the patient, and this coupling method made possible the use of large aperture medium-focussed transducers with well-defined beam patterns required for high quality imaging. The equipment underwent a number of design modifications, and then in 1969 the new technology of grey scale imaging recently developed by the group was incorporated into the scanner. As a result image quality improved significantly to the point where ultrasonic images began to have clinical relevance, and reports were issued describing the breast constituent components with precise locations of tissue disruptions when present.

Coupling methods were modified a number of times. In the first instance, the patient was in a supine position with the water-bath coupling on top of the patient. The weight of the water compressed the breast, and distorted the normal anatomy. A further modification resulted in the open tank technique in which the breasts were allowed to float without compression. The patients better tolerated the coupling, and the constituent tissues were more easily recognized. In 1974, Jack decided to position the patient on top of a large open water tank with the transducer assembly beneath. This approach, with the patient prone was significantly more comfortable, and with both breasts immersed in the water, achieved good coupling to all quadrants and the axillary tail. Breast tissues were uncompressed, and this facilitated the recognition of the anatomy. Each breast was scanned separately, and the images recorded onto a photographic film. A composite image of the whole breast could be assembled so that by displaying both breasts in a panoramic view, a direct comparison could be made between similar regions in each breast. This readily led to target imaging of suspicious lesions in either breast and their precise locations.

Jack’s contributions to breast ultrasound in collaboration with George Kossoff and Thomas Reeve of the Department of Surgery at the Royal North Shore Hospital resulted in a number of landmarks, which have become intrinsic to ultrasonic practice. A clearly distinctive observation was that malignant lesions were hypoechoic contrary to the opinion of the time, that such lesions were hyperechoic. This observation was established with bistable equipment in the late 1960s, and subsequently confirmed with grey scale when it was introduced in 1969.

Moreover, Jack’s research activities can best be described by a) the development of water-bath scanning equipment for the imaging of the breast with optimisation of focusing transducers for the introduction of grey scale echography, b) the measurement of acoustic parameters of the breast and the introduction of velocity compensation into B-mode imaging, c) the correlation of breast pathology specimens with B-mode images, d) the development of grey scale interpretative criteria for the normal and the pathological breast, e) the introduction of combined Doppler blood flow assessment and B-mode imaging of the breast, f) the extension of the grey scale interpretative criteria to include secondary features of breast lesions, and g) the evaluation of the complementary role of blood flow assessment to imaging of breast lesions.

An important aspect in developing the grey scale interpretative criteria was the collaborative study undertaken in Sydney towards the end of 1970s with Sefton Wellings, an expert in comparative pathology from the University of California at Davis, USA. The study correlated the echo producing structures found in normal breast anatomy and pathology by comparing sub-gross anatomical slices with high resolution grey scale ultrasonic breast images. From this work, Jack created a reporting protocol in two parts: the first describing the overall appearance of the breast at the level of the nipple, and the second characterising a lesion when found to be present. This protocol was an early attempt to establish a “standard reporting format” to facilitate the comparison of results from different investigators.

The first paper describing breast ultrasound was published in 1971, this was followed by a publication on grey scale breast imaging in 1975, and definitive descriptions of a range of cystic lesions was published in 1977. Jack expanded ultrasound breast examination techniques into Doppler in 1982, and this was published in 1983.

In the meantime, the ultrasonic equipment at the Royal North Shore Hospital was adapted to image the thyroid and adjacent structures in the neck for the detection tissue irregularities, and also to image the scrotum to evaluate testicular abnormalities. With grey scale imaging, tissue abnormalities and lesions were clearly displayed with an immediate clinical benefit, and a number of publications resulted from this research. During the 1970s, further research into ultrasonic imaging of the thyroid gland was undertaken with clinical collaborators of the Department of Nuclear Medicine at the Royal Prince Alfred Hospital in Camperdown, Sydney.

In 1983 the Australian company Ausonics Pty. Ltd. which had previously manufactured and marketed the UI Octoson, developed the System 1 breast and small parts scanner. This was a four transducer water-bath scanner based on the technical advances that Jack had implemented in the equipment at the Royal North Shore Hospital. The System 1 was capable of providing simple and compound scanned images from a number of different planes, and by demonstrating primary and secondary features of breast lesions, early changes resulting from benign conditions and breast cancers greater than 5mm could be displayed.

Jack was one of the founders of the Australasian Society for Ultrasound in Medicine (ASUM) when it was formed in 1970, and served as its Honorary Secretary from 1979 to 1986, and Vice President from 1989 to 1991. He has also served on the examination boards for the Diploma of Diagnostic Ultrasound (DDU) and the Diploma of Medical Ultrasonography (DMU) as well as serving on ASUM’s Education Board. In 2004, Jack was made a Life Member in recognition of his many contributions to ASUM and his commitment to education.

In 1977, the Ultrasonics Institute set up Australia’s first Ultrasound Training Course in collaboration with the Royal Hospital for Women in Paddington, with Jack as Course Coordinator. This course with local faculty members and an invited international speaker provided an intensive training programme over an eight week period that was subsequently reduced to four.

The work of the UI breast imaging group was attracting world attention, and in 1979, the First International Congress on the Ultrasonic Examination of the Breast was held in Philadelphia with more than 220 clinicians and scientists participating. As a result of this success, the International Association for Breast Ultrasound (IABU) was formed, and Jack became its first President. IABU was devoted to disseminating research and clinical results through scientific meetings every two years, and during the formative years, several Australian investigators were among its faculty. After Philadelphia, meetings were held in London, Tokyo, Sydney, New Orleans, Paris, Heidelberg, Indianapolis, Lund, Seoul, Venice and Kyoto in 2003.

The Fourth Meeting of the World Federation for Ultrasound in Medicine and Biology (WFUMB 85) was held in Sydney in1985, and Jack was Secretary General. In conjunction with WFUMB 85, the Fourth International Congress on the Ultrasonic Examination of the Breast was organised as a satellite meeting with Jack as Chairman of the Organising Committee, and also President of the Congress.

At the 1988 meeting of the World Federation of Ultrasound in Medicine and Biology (WFUMB) in Washington, Jack was presented with a “Pioneer Award” at the History of Medical Ultrasound Symposium in recognition of his many contributions to the development of breast ultrasound. In the same year, Jack was invited to join the Advisory Editorial Board of “Ultrasound in Medicine and Biology”, the official journal of WFUMB.

In 1988, Jack added to his formal academic qualifications with a Doctor of Philosophy (PhD) from the University of New South Wales. He has also been honoured by the University of Ferrara in Italy with a Doctorate in Medicine and Surgery, Honoris Causa (Hon MD) in 2001. Dedicated to researching and advancing the field of breast ultrasound, Jack has published more than seventy five scientific articles and book chapters, and has co-edited two books. He has been invited to numerous national and international meetings, and has a strong commitment to the teaching of high resolution ultrasound physics, in addition to related topics in breast disease evaluation with ultrasonic imaging and Doppler techniques.

In 1989, the Ultrasonics Institute became part of the Radiophysics Division of the CSIRO, and Jack left the following year to pursue a number of consultancy positions relating to ultrasonic breast imaging.  These include the Rachel Forster Hospital in Redfern, and Ausonics but his main focus after leaving the ultrasound group was the formation of the International Breast Ultrasound School (IBUS) based in Europe.

As a result of numerous overseas teaching commitments, Jack anticipated the need for structured high-quality courses in breast ultrasound, and in 1991 established IBUS with a number of committed colleagues. Jack was President and Chairman of the Education Board for a ten year period until 2001 during which time he directed the school’s activities; developing the curriculum and delivering high quality training programmes – based on a series of formal lectures, panel discussions, interactive case presentations, and “hands-on” practical workshops covering breast disease detection, diagnosis and management. The goals of IBUS include the improvement of breast imaging standards; the provision of high quality courses and interactive workshops; the evaluation of breast imaging techniques, and the dissemination of breast imaging information.Since its foundation, IBUS with its highly dedicated faculty of more than forty international breast disease experts has provided more than 120 courses in many parts of the world to over 12,000 participants. Jack was senior editor of more than 60 course manuals, and remains on the Executive Committee as the Founding President contributing to the school’s on going activities. Recently, the school changed its name to the “IBUS Breast Imaging School” to better describe the focus of its activities on multi-modality breast imaging education rather than being limited to ultrasound. 

In 1999, the “IBUS Guidelines for the Ultrasonic Examination of the Breast” were published in the European Journal of Ultrasound, and Jack was one of the co-authors of this important document which was adopted by a number of societies and breast assessment centres. Jack is an Honorary Associate Member of the Royal Australian and New Zealand College of Radiologists 1979, an Honorary Fellow of the American Institute of Ultrasound in Medicine 1985, and a Fellow of the Australasian College of Physical Scientists and Engineers in Medicine 1986.

Jack’s commitment to promoting international cooperation between societies and organisations devoted to breast disease assessment resulted in a membership to the Senological International Society where he became a member of the Executive Committee holding the position of Regional Vice President. As a result, he foresaw the demand to form a much-needed multidisciplinary breast disease society in Australia, and in 1995, he was instrumental in establishing a steering committee. In 1997, this eventually resulted in the formation of the Australasian Society for Breast Disease (ASBD), and an inaugural scientific meeting one year later in Surfers Paradise, Queensland attracted more than 200 registrants. Speakers covered a variety of topics devoted to developing best practice in the medical management of patients with breast disease. Cherrell Hirst from Brisbane was the first President of the Society, andJack became Honorary Secretary. In October 2017, ASBD celebrated its 20^thanniversary of its formation with a scientific meeting at the Gold Coast having an attendance of more than 460 delegates. 

Jack Jellins’ dedication to improving and maintaining the quality of breast imaging by ultrasound in Australia and around the world was recognised by the Australian Government in 2009 when he was made a member (AM) in the Order of Australia- for services to medicine through the development of diagnostic ultrasound equipment, particularly in the field of breast disease and education programs for health professionals. More recently, Jack was awarded the title of Adjunct Professor in the Discipline of Medical Radiation Sciences in the Faculty of Health Sciences at the University of Sydney where hecontinues to contribute to the advancement of breast imaging. He shares his time between family and professional responsibilities, and enjoys the rewards of a life dedicated to research that has contributed to a better outcome in healthcare.

References.

• Kossoff, G. (Nov. 2000). How research into medical ultrasound began in Australia, ASUM Bulletin, Vol 3: Number 4:8.
• Jellins, J., Kossoff, G., Buddee, F.W. and Reeve, T.S. (1971). Ultrasonic visualisation of the breast. Med. J. Aust. 1:305.
• Jellins, J., Kossoff, G., Reeve, T.S. and Barraclough, B.H. (1975). Ultrasonic grey scale visualisation of breast disease. Ultrasound Med. Biol. 1:393.
• Jellins, J., Kossoff, G., Wiseman, J., Reeve, T.S. and Hales, I. (1975). Ultrasonic grey scale visualisation of the thyroid gland. Ultrasound Med. Biol. 1:405.
• Jellins, J., Kossoff, G. and Reeve, T.S. (1977). Detection and classification of liquid filled masses in the breast by grey scale echography. Radiology 125:205.
• Jellins, J. and Barraclough, B.H. (1978). Ultrasonic imaging of the scrotum. Ultrasound in Medicine. Eds. D. White and E.A. Lyons, Vol. 4, 151. Plenum Press, New York.
• Jellins, J., Reeve,  T.S., Wellings, S.R.,  Barraclough, B.H. and Kossoff, G. (1981). A standardized reporting format for breast examinations, 364-368. In: Recent Advances in Ultrasound Diagnosis 3, Eds. A. Kurjak and A. Kratochwil,  Excerpta Medica,  Amsterdam.
• Jellins, J., Kossoff, G., Boyd, J. and Reeve, T.S. (1983). The Complementary Role of Doppler to the B-Mode Examination of the Breast. J. Ultrasound Med. 2, 10: 295.
• Home Page for IBUS and the IBUS Breast Imaging School – http://www.ibus.org

Copyright © 2018, J Jellins <jjellins@ibus.org>

L Wilson PhD, 7 August 2018

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